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I 'FKANKLlHXMARgHAU.- 



Property of the 

Lancaster City and County 
Medical Society 



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Received, 

Title, k:2J..L.<^..i*?.. 



\ Binding, 



Owner 
Residence, 
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THE 



AIEKICAN JOUENAL 



OF THE 



MEDICAL SCIENCES. 



EDITED BY 



ISAAC HAYS, M.D., 

SURGEON TO WILLS' HOSPITAL. 

FELLOW OF THE PHILADELPHIA COLLEGE OF PHYSICIANS ; MEMBER OF THE 
AMERICAN MEDICAL ASSOCIATION ] OF THE AMERICAN PHILOSOPHICAL SOCIETY j OF THE 
ACj^JEMY OF NATURAL SCIENCES OF PHILADELPHIA, 

&c. &c. &c. 



NEW SERIES. 
VOL. XXV. 




PHILADELPHIA: 
BLANCHARD & LEA. 

1853. 



69451 



i 



Entered according to Act of Congress, in the year 1858, by 
BLANCHARD AND LEA, 
the Clerk's Office of the District Court of the Eastern District of Pennsylvania. 




PHILADELPHIA : 
T. K. AND P. G. COLLINS, PRINTERS. 



TO READERS AND CORRESPONDENTS. 



It will afford us great pleasure to receive the papers which Dr. Churchill, 
of Dublin, and Dr. Hirsch, of Dantzic, propose to send us. 

In our No., for July last we made some remarks relative to the publication 
of the same article in other journals simultaneously with our own; we now 
take pleasure in stating that the author to whom allusion was made was absent 
in Europe at the period of the appearance of his paper, and he has given us satis- 
factory assurance that he did not design its publication elsewhere until after 
July. We have every reason to believe that the communication was intended 
to be original for the American Journal of the Medical Sciences. 

The following works have been received: — 

Medico-Chirurgical Transactions. Published by the Royal Medical and Chirur- 
gical Society of London. Vol. XXXV. London, 1852. (From the Society.) 

On Syphilis, Constitutional and Hereditary; and on Syphilitic Eruptions. By 
Erasmus Wilson, F. R. S., &c. With four coloured plates. Philadelphia: 
Blanchard & Lea, 1852. (From the Publishers.) 

General Pathology, as conducive to the Establishment of Rational Principles 
for the Diagnosis and Treatment of Disease ; a Course of Lectures delivered 
at St. Thomas's Hospital during the Summer Session of 1850. By John Simon, 
F. R. S., one of the Surgical Staff of that Hospital. Philadelphia: Blanchard 
& Lea, 1852. (From the Publishers.) 

Principles of Huma^ Physiology, with their Chief Applications to Psychology, 
Pathology, Therapeutics, Hygiene, and Forensic Medicine. By Wm. B. Car- 
penter, M. D., F. R. S., F. G. S., Examiner in Physiology and Comparative Ana- 
tomy in the University of London, &c. &c. Fifth American from the fourth 
and enlarged London edition. With three hundred and fourteen illustrations. 
Edited, with additions, by Francis Gurney Smith, M. D., Professor of the 
Institutes of Medicine in the Medical Department of Pennsylvania College, 
&c. &c. Philadelphia: Blanchard & Lea, 1853. (From the Publishers.) 

Handbooks of Natural Philosophy and Astronomy. By Dionysius Lard- 
ner, D. C. L., formerly Professor of Natural Philosophy and Astronomy in 
University College, London. Second Course : Heat, Magnetism, Common Elec- 
tricity, Voltaic Electricity. Illustrated by upwards of two hundred engravings 
on wood. Philadelphia: Blanchard & Lea, 1853. (From the Publishers.) 

A System of Operative Surgery, based upon the Practice of Surgeons in the 
United States ; and containing a Bibliographical Index and Historical Record 
of many of their Operations, during a Period of Two Hundred Years. By 
Henry H. Smith, M.D., Surgeon to St. Joseph's Hospital, &c. &c. &c. Illus- 
trated by numerous steel plates. Philadelphia : Lippincott, Grambo, & Co., 
1852. (From the Publishers.) 

Appendix (C) to the Report of the General Board of Health on the Epidemic 
Cholera of 1848 and 1849. Abstract of Report, by James Wynne, M. D., on 
Epidemic Cholera, as it prevailed in the United States in 1849 and 1850. Pre- 
sented to both Houses of Parliament by command of Her Majesty. London, 
1852. (From the Author.) 

The Transactions of the Illinois State Medical Society for the year 1852. 
Peoria, 1852. ' 

Proceedings of the Third Annual Session of the Indiana State Medical So- 
ciety, held in the City of New Albany, May, 1852. New Albany, Indiana, 
1852. 

Quarterly Summary of the Transactions of the College of Physicians pf Phi- 
ladelphia from August to October 6, 1852. 



4 



TO READERS AND CORRESPONDENTS. 



The Physician's Visiting List, Diary, and Book of Engagements for 1853. 
Philadelphia: Lindsay & Blakiston. (From the Publishers.) 

A Practical Treatise on Dental Medicine : being a Compendium of Medical 
as connected with the Study of Dental Surgery ; to which is appended an In- 
quiry into the Use of Chloroform and other Anaesthetic Agents. Second edi- 
tion, corrected and enlarged. By T. E. Bond, A. M., M. D. Philadelphia : 
Lindsay & Blakiston, 1852. (From the Publishers.) 

Notes on Carpenter's Human Physiology; containing some Original Views of 
the Economy of Nature, the Result of Reasoning founded on Observation. By 
Louis Mackall, M. D. Washington, 1852. 

An Account of the Reasoning Process. By Louis Mackall, M. D. Wash- 
ington, 1850. 

Letters on Syphilis; addressed to the Editor of the Union Medicale. By 
Ph. Ricord, Chirurgien de l'Hopital du Midi, &c. With an Introduction by 
Amedee Latour. Translated by W. P. Lattimore, M. D. Philadelphia: A. 
Hart, 1852. (From the Publisher.) 

The Physician's Pocket, Dose, and Symptom Book: containing the Doses and 
Uses of all the Principal Articles of the Materia Medica and Chief Officinal 
Preparations: also, Tables of Weights and Measures, &c. &c. &c. By Joseph 
Wythes, M.D., author of the Microscopist, &c. Philadelphia: Lindsay & 
Blakiston, 1852. (From the Publishers.) 

Nature in Disease. An Address before the Norfolk District Medical Society 
of Massachusetts, at the Annual Meeting, May 18, 1852. By F. E. Cotting, 
M. D. Boston, 1852. 

The Present Mental Attitude and Tendencies of the Medical Profession. 
Inaugural Address of Worthington Hooker, M. D., as Professor of the Theory 
and Practice of Medicine in Yale College. Delivered in the College Chapel, 
Oct. 2, 1852. New Haven, 1852. (From the Author.) 

Superiority of Sanitary Measures over Quarantine. An Address delivered 
before the Suffolk District Medical Society at its Third Anniversary Meeting, 
Boston, April 24, 1852. By Henry G. Clark, M. D., one of the Surgeons to 
the Massachusetts General Hospital. Printed by request of the Society. Bos- 
ton, 1852. (From the Author.) 

Biographical Sketch of J. Kearney Rodgers, M.D., &c. &c. By Edward 
Delafield, M. D. Read before, the New York Academy of Medicine, Oct. 6, 
1852, and published under its authority. New York, 1852. (From the Au- 
thor.) 

Popular Address of Dr. W. F. Barr before the Medical Society of East Ten- 
nessee. Knoxville, 1852. (From the Author.) 

An Introductory Lecture delivered on the Opening of the Session of the 
Medical School, Charing-Cross Hospital, London, Oct. 1, 1852. By Edward 
Smith, M. D., LL. B., B. A. Lond., &c. &c. London, 1852. (From the Au- 
thor.) 

On the Non-Contagious Character of Puerperal Fever: an Introductory Lec- 
ture. By Hugh L. Hodge, M. D.« Professor of Obstetrics in the University of 
Pennsylvania. Delivered Oct. 11, 1852. Philadelphia, 1852. (From the 
Author.) 

A Discourse on the Times, Character, and Writings of Hippocrates. By 
Elisha Bartlett, M. D., Prof. Mat. Med. and Med. Jurisp. Coll. of Phys. and 
Surg., N. Y. Published by the Class. New York, 1852. (From the Author.) 

Introductory Lecture to the Course of Chemistry. Delivered in Jefferson 
Medical College, Oct. 13, 1852. By Franklin Bache, M. D. Published by the 
Class. Philadelphia, 1852. (From the Author.) 

The Moral Character of the Medical Profession. An Address introductory 
to the Course of Public Lectures in the New York Medical College. Session of 
1852-53. By E. R. Peaslee, A. M., M. D., Prof. Phys. and Path. Published 
by the Class. New York, 1852. (From the Author.) 

An Address on the Life and Professional Character of Samuel B. Latta, M. D. 
By M. B. Wright, M. D., late Professor in the Medical College of Ohio. (From 
the Author.) 

A Memoir on the Life and Character of James B. Rogers, M. D., Professor 



TO READERS AND CORRESPONDENTS. 



5 



of Chemistry in the University of Pennsylvania. By Joseph Carson, M. D., 
Prof, of Mat. Med. and Pharm. in University of Pennsylvania. Published by 
the Class. Philadelphia, 1852. (From the Author.) 

Materia Medica or Pharmacology and Therapeutics. By Wm. Tully, M. D. 
Vol. I. No. 1. November, 1852. Springfield, 1852. (From Dr. J. Church.) 

Proceedings of the National Pharmaceutical Convention held in Philadel- 
phia Oct. 6, 1852. Published by direction of the Convention. Philadelphia, 
1852. 

Syllabus of a Course of Lectures on Diseases of the Eye, at the New York 
Ophthalmic Hospital. By Mark Stephenson, M. D. New York, 1852. (From 
the Author.) 

The Fifth Annual Keport of the Regents of the University on the Condition 
of the State Cabinet of Natural History, and the Historical and Antiquarian 
Collection annexed thereto. Albany, 1852. (From Dr. T. R. Beck.) 

The following Journals have been received in exchange : — 

Journal des Connaissances Medico-Chirurgicales. Public par le Dr. A. Mar- 
tin Lauzer. May, June, July, August, 1852. 

The Dublin Quarterly Journal of Medical Science. November, 1852. 

Medical Times and Gazette. September, October, November, 1852. 

Dublin Medical Press. September, October, November, 1852. 

The Retrospect of Medicine : being a Half-Yearly Journal. Edited by W. 
Braithwaite, Lecturer on Obstetric Medicine, &c. January, June, 1852. 

Provincial Medical and Surgical Journal. Edited by J. H. Walsh, Esq., 
F. R. C. S. September, October, November, 1852. 

London Journal of Medicine. September, October, 1852, 

The Journal of Psychological Medicine and Mental Pathology. Edited by 
Forbes Winslow, M. D. October, 1852. 

The British and Foreign Medico-Chirurgical Review. October, 1852. 

Monthly Journal of Medical Science. Edited by Professors Christison, 
Symes, Simpson, Bennett, and Drs. Maclagan and Robertson. October, No- 
vember, December, 1852. 

Canada Medical Journal. Edited by R. L. Macdonnell, M. D., and A. H. 
David, M. D. September, October, November, December, 1852. 

The New York Journal of Medicine. Edited by S. S. Purple, M. D. Sep- 
tember, 1852. 

The American Journal of Pharmacy. Edited bv Wm. Procter, Jr. October, 
1852. J 3 

Southern Medical and Surgical Journal. Edited by L. A. Dugas, M. D. Oc- 
tober, November, December, 1852. 

N. W. Medical and Surgical Journal. Edited by W. B. Herrick, M. D., 
assisted by B. A. Johnson, M. D. September, October, November, 1852. 

Boston Medical and Surgical Journal. Edited by J. N. C. Smith, M. D. 
October, November, December, 1852. 

Transylvania Medical Journal. Edited by L. J. Frazee, M. D. September, 
October, November, December, 1852. 

[No. 1. Vol. II. of this Journal has not reached us.] 

New York Medical Times. Edited by H. D. Buckley,'M. D. October, No- 
vember, December, 1852. 

The Medical Examiner. Edited by F. G. Smith, M. D., and John B. Biddle, 
M. D. October, November, December, 1852. 

L'Union Medicale cle la Louisiane. Redacteurs C. Delery, M. P. B., et E. 
Martin, D. M. P. Nos. 9, 10, 1852. 

The New Jersey Medical Reporter. Edited by Joseph Parrish, M. D. Oc- 
tober, November, December, 1852. 

Buffalo Medical Journal. Edited by Austin Flint, M. D. October, Novem- 
ber, December, 1852. 

The Western Journal of Medicine and Surgery. Edited by L. P. Yandell, 
M. D., and T. S. Bell, M. D. October, November, December, 1852. 

Medical Recorder. By the Memphis Medical College. October. November, 
1852. 



6 



TO READERS AND CORRESPONDENTS. 



The New Orleans Monthly Medical Register. Edited by A. F. Axson, M. D. 
October, November, 1852. 

The Western Medico-Chirurgical Journal. Edited by J. F. Sanford, M.D. 
October, November, 1852. 

The American Journal of Science and Arts. Conducted by Professor B. 
Silliman and B. Silliman, Jr., and James D. Dana, and Dr. W. Gibbs. No- 
vember, 1852. 

The New Hampshire Journal of Medicine. E.H.Parker, M. D., Editor. 
October, November, December, 1852. 

The American Journal of Insanity. Published by the New York State Lu- 
natic Asylum, Utica. October, 1852. 

The Western Lancet and Hospital Reporter. Edited by L. M. Lawson, M. D., 
and George Mendenhall, M. D. October, November, 1852. 

The New Orleans Medical and Surgical Journal. Edited by A. Hester. 
November, 1852. 

The Stethoscope and Virginia Medical Gazette. Edited by P. C. Gooch, M.D. 
October, November, December, 1852. 

The Ohio Medical and Surgical Journal. Edited by Richard L. Howard, 
M. D. November, 1852. 

The American Journal of Dental Science. Edited by Cbtapin A. Harris, 
M. D., D. D., and A. A. Blandy, M. D., D. D. S. October, 1852. 

The Charleston Medical Journal and Review. Edited and published bv D. 
J. Cain, M. D., and F. P. Porcher, M. D. November, 1852. 

The St. Louis Medical and Surgical Journal. November and December, 
1852. 

The New York Journal of Pharmacy. Published by Authority of the College 
of Pharmacv of the City of New York. Edited by B. W. McCready, M. D. 
December, 1852. 

[The Nos. of this Journal for April, May, June, July, August, September, October, and 
November have not reached us.] 



Communications intended for publication, and Books for Review, should be sent, free 
of expense, directed to Isaac Hays, M. D., Editor of the American Journal of the Me- 
dical Sciences, care of Messrs. Blanchard & Lea, Philadelphia. Parcels directed as 
above, and (carriage paid) under cover, to John Miller, Henrietta Street, Covent Gar- 
den, London; or to John Wiley or G. P. Putnam, New York; or W. D. Ticknor, Bos- 
ton ; or M. Hector Bossange, Lib. quai Voltaire, No. 11, Paris, will reach us safely 
and without delay. We particularly request the attention of our foreign correspond- 
ents to the above, as we are often subjected to unnecessary expense for postage and 
carriage. 

All remittances of money, and letters on the business of the Journal, should be ad- 
dressed exclusively to the publishers, Messrs. Blanchard & Lea. 

The advertisement-sheet belongs to the business department of the J ournal, 
and all communications for it should be made to the publishers. 



CONTENTS 



OF THE 

AMERICAN JOURNAL 

OF THE 

MEDICAL SCIENCES. 

NO. XLIX. NEW SERIES. 
JANUARY, 1853. 



ORIGINAL COMMUNICATIONS. 
MEMOIRS AND CASES. 

ART. PAGE 

I. On the Use of Bebeerine and Cinchonia in the Treatment of Intermit- 
tent Fever. By Wm. Pepper, M. D., one of the Physicians of the Penn- 
sylvania Hospital. - - - - - - - -13 

II. Medical and Surgical Notes of Campaigns in the War with Mexico, 
during the years 1845, 1846, 1847, and 1848. By John B. Porter, M. D., 
Surgeon U. S. Army. (Continued from Vol. XXIV. p. 30.) - - 25 

III. The Practical Application of the Microscope to the Diagnosis of Can- 
cer. By Francis Donaldson, M. D., Baltimore, Maryland. With three 
Plates, representing Cancer and other Histological Elements. - - 43 

IV. Extracts from the Records of the Boston Society for Medical Improve- 
ment. By Wm. W. Morland, M. D., Secretary. - - - - 71 

V. Observations on the Use of Potash in the Treatment of Scurvy ; with 
Cases. By William A. Hammond, M. D., Assist. Surg. U. S. Army. - 102 

VI. Some Observations and Critical Remarks upon the Arcus Senilis,, as 
a Diagnostic Symptom of Fatty Degeneration of the Heart. By E. B. 
Haskins, M. D., of Clarksville, Tenn. - - - - - 105 

VII. An Account of the last Illness of the late Honorable Daniel Web- 
ster, Secretary of State with a description of the Post-mortem Appear- 
ances, &c. By John Jeffries, M. D. - - - - - 110 

VIII. Report of a Case of Extensive Disease of the Cervical Vertebrae; 
with Remarks on this and some other Forms of Carious Disease of the 
Spine. By Buckminster Brown, M. D., of Boston. - - -120 

IX. Case of Accidental Poisoning with half an ounce of Tartar Emetic, 
successfully treated with Green Tea and Tannin. By Stephen A. 
McCreery, M. D., U. S. N. (Communicated by Thomas Harris, M. D., 
Chief Bureau Med. and Surg., U. S. N.) 131 

X. Obstetrical Cases. By Isaac Gr. Porter, M. D., New London, Ct. - 133 

XI. Case of Curious Inflammation and Hypertrophy of Womb. By 
Charles D. Meigs, M. D., Professor of Obstetrics and Diseases of Women 
and Children in Jefferson Medical College. (With a plate.) - * -137 



8 



CONTENTS. 



REVIEW. 

ART. PAGE 

XII. The Transactions of the American Medical Association. Instituted 
1847. Vol. V. Philadelphia, 1852: 8vo. pp. 940. - - - 139 

BIBLIOGRAPHICAL NOTICES. 

XIII. Clinical Reports on Continued Fever, based on an Analysis of One 
Hundred and Sixty-Four Cases, &c. By Austin Flint, M. D., Buffalo, 
1852: 8vo, pp. 390. 163 

XIV. Operative Surgery Illustrated : containing more than nineteen hun- 
dred Engravings ; including two hundred Original and fifty Coloured 
Drawings, with Explanatory Text. By R. U. Piper, M. D. Also, a 
Chapter upon the Use of Ether in Surgery, from the Transactions .of 
the American Medical Association, written, at the Request of a Surgical 
Committee of that body, by Henry J. BIgelow, M. D., Professor of Sur- 
gery in the Medical School of Harvard University. Boston : Ticknor, 
Reed, & Fields, 1852 : 8vo. pp. 384. - - - - 165 

XV. Second Report of the General Board of Health on Quarantine. Yellow 
Fever. Presented to both Houses of Parliament, by command of Her 
Majesty. London, 1852 : 8vo. pp. 414. 

Appendix (C) to the Report of the General Board of Health on the Epidemic 
Cholera of 1848 and 1849. Abstract of Report, by James Wynne, M. D., 
on Epidemic Cholera, as it prevailed in the United States in 1849 and 
1850. Presented to both Houses of Parliament, by command of Her 
Majesty. London, 1852: 8vo. pp. 93. 

Further Observations on that portion of the Second Report on Quarantine <* 
by the General Board of Health, which relates to the Yellow Fever Epi- 
demic on Board Her Majesty's Ship Eclair, and at Boa Vista in the Cape 
De Verde Islands. By J. *0. McWilliam, M. D., F. R. S., R. N., Medi- 
cal Inspector of Her Majesty's Customs. London, 1852 : 12mo. pp. 40. - 167 

XVI. General Pathology, as conducive to the establishment of Rational 
Principles for the Diagnosis and Treatment of Disease. A Course of Lec- 
tures, delivered at St. Thomas's Hospital during the Summer Session of 
1850. By John Simon, F. R. S., one of the Surgical Stan 7 of that Hospital, 
and Officer of Health to the City of London. Blanchard & Lea, Phila- 
delphia, 1852 : 8vo. pp. 211. - - - - - - 171 

XVII. Recherches sur la Locomotion du Cceur. Par A. A. Verneuil, Doc- 
teur en Medecine, etc. etc. Paris, 1852 : 4to. pp. 58. An Inquiry into 
the Locomotion of the Heart. By A. A. Verneuil, M. D. ■* , - 172 

XVIII. Principles of Human Physiology, with their Chief Applications to 
Psychology, Pathology, Therapeutics, Hygiene, and Forensic Medicine. 
By W. B. Carpenter, M. D., F. R. S., F. G. S., Examiner in Physiology and 
Comparative Anatomy in the University of London, &c. &c. Fifth Ame- 
rican from the fourth and enlarged London edition. With three hun- 
dred and fourteen illustrations. Edited, with additions, by Francis 
Gurney Smith, M. D., Prof, of the Institute's of Medicine in the Medical 

■ Department of Pennsylvania College, &c. Philadelphia : Blanchard & 
Lea, 1853 : 8vo. pp. 1091. 179 

XIX. The Principles and Practice of Dental Surgery. By Chapin A. Har- 
ris, M. D., D. D. S., Professor of the Principles and Practice of Dental 
Surgery in the Baltimore College. Fifth edition, with two hundred and 
thirty-six illustrations. Lindsay & Blakiston, Philadelphia, 1853 : pp. 
812. - - - - - - - - - 179 

XX. Quarterly Journal of Microscopical Science, including the Trans- 
actions of the Microscopical Society of London. Edited by Edwin Lan- 
kester, M. D., F. R. S., F. L. S.; and George Busk, F. R. C. S. E., F. R. S., 

F. L. S. No. 1, October, 1852 ; with four lithographic illustrations. - 180 



CONTENTS. 



9 



QUARTERLY SUMMARY 

OF THE 

IMPROVEMENTS AND DISCOVERIES IN THE 
MEDICAL SCIENCES. 



FOREIGN INTELLIGENCE. 

Anatomy and Physiology. 

PAGE 

1. Defence of the Doctrine of Vital 
Affinity, against the Objections 
stated to it by Humboldt and Dr. 
Daubeny. By Dr. Alison. - 181 

2. Contributions to the Physiology 
of Vision. — On some remarkable 
and hitherto unobserved Pheno- 
mena of Binocular Vision. By 
Charles Wheatstone, F. R. S. - 182 

3. Respiration of Muscles. By G. 
Liebig. - V - - 184 



PAGE 

4. Hermaphrodite Formation. By 
Samuel Stuart, Esq. - - 185 

5. Muscularity of the Valve which 
closes the Foramen Ovale. By 
Dr. Peacock. - - - - 185 

6. On the Structure and Develop- 
ment of Bone. By John Tomes, 
F. R. S., and Campbell de Mor- 
gan, Esq. - - - - - 186 



Organic Chemistry. 



7. On the Condition of Albumen 

in the Economy. By M. Mialhe. 189 

8. On the Habitual Presence of 



Sugar in the Urine of the Aged. 
By M. Dechambre. - - - 190 



Materia Medica and Pharmacy. 



9. Cod-Liver Oil. By Dr. Winck- 
ler. - 190 

10. Sulphate of Nickel as a Thera- 
peutic Agent. By Prof. Simpson. 191 

11. Therapeutic Action of Furfu- 
rine. By Professor Simpson. - 192 

12. Experiments with Digitaline*. 
performed by M. Andral in the 
Hopital de la Charite. By Dr. 
Lemaistre. - 192 

13. On the Action and on the Me- 
thod of preparing Cathartine. 

By Trenkler. - - - - - 195 

14. On the Action of Trisnitrate 

of Bismuth. By Dr. Lussana. 195 

15. On the Action of Iodine. By 

M. Bonnet. - - - - 195 



16. On the Effects of Iodine on the 
Glandular System. By Dr. T. 

H. Silvester. - - - - 196 

17. New Mode of employing Io- 
dine. By M. Hannon. - - 197 

18. Urea as a Diuretic. By Dr. T. 

H. Tanner. - - - - 197 

19. Chromic Acid as an Escharo- 
tic. By Dr. Heller. - - - 198 

20. Copahine-Mege. By M. Jozeau. 198 

21. Opianine, a New Base of Opi- 
um. By Dr. Hinterberger. - 199 

22. Solvent for Disulphate of Qui- 

na. - - - - - 199 

23. Pagliari's Haemostatic. By 

M. Sedillot. - - - - 199 



10 



CONTENTS. 



Medical Pathology and Therapeutics, and Practical Medicine. 



24. Curability of Insanity. By 
Dr. Forbes Winslow. - - 200 

25. Pathology of Insanity. By 
Dr. Forbes Winslow. - - 201 

26. Medical Treatment of Insanity. 

By Dr. Forbes Winslow. - - 201 

27. New Researches on the Cura- 
bility of Softening of the Brain. 

By Dr. Durand-Fardel. - - 208 

28. Eruptive Fevers. By Prof. 
Bennett. 209 

29. Scarlatina. By Prof. Bennett. 210 

30. On an Epidemic " Suette Mili- 
aire," in the Herault. By Dr. 
Swaine. ----- 212 

31. A Comparative View of some 
of the more Important Points of 
the Pathology of Rheumatic and 
Non-Rheumatic Pericarditis, de- 
duced from an Analysis of Cases. 

By Dr. Ormerod. - - - 213 

32. Recent Researches on Hsema- 



PAGE 

tology. By MM. Becquerel and 
Rodier. 215 

33. Microscopic Examination of a 
Relaxed Uvula. By Dr. T. In- 
man. 216 

34. Cirrhosis of the Liver. By Dr. 
Bennett. 217 

35. On the Proportion of the Sub- 
jects, bitten by Mad Animals, 
who become affected with Hy- 
drophobia. By M. Renault. - 218 

36. Stomatitis Ulcerosa of Chil- 
dren. By Dr. F. W. Mackenzie. 219 

37. Removal of the Obstructing 
Mucus in the Suffocative Bron- 
chitis of Infants. ByM.Valleix. 220 

38. Treatment of Amenorrhoea. 

By H. Bennett, M. D. - - 220 

39. A New Method of Ausculting 
the Eustachian Tube. By Prof. 
Richter. 223 



Surgical Pathology and Therapeutics, and Operative Surgery. 



40. Hospital Gangrene. By G. J. 
Guthrie, Esq. - - - - 223 

41. On the Cure of Nsevus and Erec- 
tile Tumours by Elastic Subcuta- 
neous Strangulation and Section. 
By Dr. Startin. - - - 225 

42. Result of the Ligature of the 
Large Arteries in eighty-two 
cases occurring in the practice 

of M. Roux. r - ^ - - 226 

43. Compression in Aneurism. By 
Mr. Critchett. - - _ - 227 

44. Cases of Popliteal Aneurism 
cured by Pressure. By Dr. W. 

K. Swettenham. - - - 228 

45. On a New Mode of Operating 
in Varicose Aneurism. By M. 
Malgaigne. - - - - 228 

46. Ligature of the Vertebral Ar- 



terv in a case of Gunshot Wound. •* 
By M. Maisonneuve. - - 228 

47. Microscopic Examination of 
Cancer. By Dr. Murchison. - 229 

48. On Cancroid, or Epithelial 
Cancer. By M. Maisonneuve. - 230 

49. Statistics of Operations for 
Cancer. _ By Prof. Paget - 231 

50. On Discharge of Fluid from 
the Nipple in Innocent Tumours 

of the Breast. By M. Richard. 231 

51. On the Treatment of Epistaxis. 

By M. Reveille-Parise. - - 231 

52. Sal Ammoniac in Enlarged 
Prostate. By M. Fischer. - 232 

53. Dislocation of the Humerus 
Forwards and Upwards. By 
Mr. R. G. H. Butcher. - - 232 

54. Pelvic Abscesses. By Dr. 
Fleetwood Churchill. - - 233 



Ophthalmology. 



55. On the Contractile Tissue of 
the Iris. By Joseph Lister, 

B. A. 237 

56. A New Method for the more 
Exact Examination of the Eye. 

By Dr. John Czermak. - ^ - 243 

57. Mr. Bowman's New Operation 



for the Division and Removal of 
False Membrane or Opaque Cap- 
. sule from the Axis of Vision. - 245 
58. Amaurosis from Concussion. 
Treatment by Mercury. Reco- 
very. By Mr. Wormald. - 246 



CONTENTS. 



11 



Midwifery. 



59. Case of Arm-Presentation suc- 
cessfully conducted without 
Turning. By Dr. R. G. Mayne. 247 

60. Supposed Extra-Uterine Ab- 
dominal Pregnancy; Natural 
delivery. By M. Huguier. - 248 

61. Induction of Premature La- 
bour by the Method of Professor 
Kiwisch. By Dr. Tyler Smith. 249 

62. Induction of Abortion in the 
Vomiting of Pregnant Women. 

By MM. Dubois and Stoltz. - 250 



PAGE 

63. Stethoscopic Sign of Separa- 
tion of the Placenta. By Prof. 
Simpson. 251 

64. On Unavoidable Uterine He- 
morrhage. By M. Depaul. - 251 

65. On the Continuance of Lac- 
tion during the Progress of Dis- 
eases. By Dr. Roser. - - 253 

66. Epidemic of Puerperal Gan- 
grenous Vulvitis. By M. Cha- 
vanne. - 253 



Medical Jurisprudence and Toxicology. 



67. Infanticide, and what may be 
confounded with it. By Dr. 
Weber. 254 

68. Whether a Blow on the Head, 
producing Fracture of the Skull, 
ever causes Immediate Death ? 254 

69. Vomiting produced by the 
Application of Galvanism. - 255 

70. On Suicide by Strangulation 
without Suspension. By N. 
Jacquier. - - - 255 

71. Camphor in cases of Poisoning 

by Strychnine. By Dr. Pidduck. 255 

72. On the Qualitative Separation 
of Arsenic, Tin, and Antimony. 

By George F. Ansell. - - 255 

73. Remarkable Case of Suicide 

by Hanging. By F. C. Webb. 256 

74. Poisonous Qualities of the Ker- 
nel of the Apricot. - 256 



75. Wounds and Injuries of the 
Bladder. 257 

76. Sir Benjamin Brodie on the 
Operation of Poisons. - - 257 

77. On Poisoning by Sulphate of 
Iron. By M. Orfila. - - 259 

78. On Poisoning by Tartaric 
Acid. By MM. Devergie and 
Orfila. - - - - - 260 

79. On the Deprivation of the 
Noxious Power of Poisonous 
Mushrooms. By M. Gerard. - 261 

80. On Spontaneous Human Com- 
bustion. By M. Devergie. - 261 

81. Strangulation. Longitudinal 
Rupture of Trachea. Suicide 

or Homicide. - 262 

82. Life Insurance. - - - 263 



AMERICAN INTELLIGENCE. 
Original Communications. 



Splint for Fracture of the Lower 
End of the Radius. By Isaac 
Hays, M. D. - - - - 265 

Traumatic Tetanus relieved by the 
Inhalation of Chloroform. By 
Thos. T. Russell, M. D. - - 266 

Bean in the Trachea — Tracheoto- 
my — Cure. By Moses C. Hoyt, 
M. D. 267 

Anatomical Lesions in Stomatitis 



Materna and their Treatment. 
By J. C. Hubbard, M. D. - 269 

A Case of Scrofulous Inflammation 
of the Lower Lobes of the Right 
Lung. By J. Hallowell, M. D. 270 

Case of Strangulated Inguinal 
Hernia successfully treated by 
the Cold Douche. By Edward 
Warren, M. D. - - - - 271 

Chalybeate Spring on Petty's Is- 
land. By James C. Booth. - 271 



12 



CONTENTS. 



Domestic Summary. 



PAGE 

Fracture of the Cranium, with De- 
pression, followed by Tetanus. 
By Prof.E. Geddings. - -272 

Operation of Tracheotomy in an 
Epileptic. By Dr. John Neill. - 274 

Excision of the Superior and Infe- 
rior Maxillary Bones. By Prof. 
S. D. Gross. - - m - - 276 

Total Removal of the Clavicle. By 
A. J. Wedderburn. - - - 277 



PAGE 

Bite of the Rattlesnake. By Lieut. 
J. C. Woodruff, U. S. A. - - 278 

Yeratrum Yiride, American Helle- 
bore. By Dr. W. C. Norwood. 280 

Snoring Prevented. Excision of 
the Uvula. By Dr. L. A. Dugas. 282 

Boletus Laricis, or White Agaric, 
as a Purgative. By Wm. M. 
McPheeters. - - - - 282 

Quinine in Typhus Fever. By Dr. 
John Douglass. - - - 282 



Obituary Notice of Jesse Young, M. D. By Joshua Owens, M. D. - - 282 



THE 

AMERICAN JOTJKNAL 
OF THE MEDICAL SCIENCES 

FOE JANUARY 1 8 5 3. 



Art. I. — On the Use of Bebeerine and Cinehonia in the Treatment of Inter- 
mittent Fever. By Wm. Pepper, Mr. D., one of the Physicians of the 
Pennsylvania Hospital. 

The high price of quinia, and the apprehension in the minds of some 
lest the supply of this important preparation might ultimately fail to meet 
the increasing demand, have naturally induced medical men to investigate 
the antiperiodic or febrifuge properties of other remedies. Arsenic, copper, 
zinc, and iron; as also dogwood, willow, oak, and numerous other tonics, have 
from time to time been used with more or less success in intermittent fever; 
but, with the exception of the first named, most of the remedies have been 
in a great measure abandoned in the treatment of this disease. 

Quite recently, the attention of the profession has been directed to the 
sulphate of bebeerine as being possessed of very decided tonic and anti- 
periodic power. This remedy was first introduced into general notice by Dr. 
Kodie, of the British Navy, and was afterwards more fully investigated by 
Dr. Maclagan, of Edinburgh. He found the sulphate possessed of conside- 
rable febrifuge power, scarcely inferior to the same salt of quinia, and in some 
respects even preferable to it ; thus it is reported to be less stimulating, and 
not so prone to produce headache, singing in the ears, or deafness. By some 
it has even been asserted that relapses are less frequent after its use than after 
the sulphate of quinia. From these flattering accounts, I was induced, during 
the month of June last, to administer this remedy in four of the cases of inter- 
mittent fever reported below (Cases XIV., XV., XVI., 'and XVII). By refer- 
ring to these cases, it will be perceived that in two of them it proved promptly 
successful, whilst in the remaining two it entirely failed, and had to be 
abandoned. In one instance, the patient relapsed at the end of one week, and 
although the bebeerine was again freely administered, it only tended to mitigate 
No. XLIX.— Jan. 1853. 2 



14 Pepper, Bebeerine and Cinchonia in Intermittent Fever. [Jan. 

or modify the disease. It certainly did not appear to produce headache, 
tinnitus aurium, or acceleration of the pulse ; in one case, however, when 
given in large doses, it provoked vomiting. The bebeerine, though less bitter 
than quinia, is more nauseous, and therefore more liable to be rejected in 
cases where the stomach is delicate. Judging from the limited number of 
cases in which I have seen this remedy used, it appears to be less efficacious 
than the sulphate of cinchonia or quinia, though at the same time it must be 
admitted to possess very decided febrifuge powers, and may, perhaps, be well 
adapted for many of those cases where constitutional peculiarities render the 
preparations of bark objectionable. Dr. Patterson, in the Medical Examiner 
for May, 1852, has reported two cases of obstinate intermittent, in which the 
bebeerine effected a permanent cure after the failure of quinia. In Demerara, 
a decoction of the nut is the common remedy for this disease, and is said to 
Be most generally successful. Notwithstanding these favourable reports, how- 
ever, it is evident that a more extended observation is still necessary to esta- 
blish fully the true value of this new remedy. 

The more immediate object of the present communication, however, has 
been to invite the attention of the profession in this country to the undoubted 
efficacy of sulphate of cinchonia in the treatment of intermittent fevers. 
Hitherto, this important alkaline principle appears to have been thrown aside 
as possessing little or no value, or used by the more dishonest, simply for the 
adulteration of quinia ; and this erroneous impression, as to the comparative 
inefficacy of cinchonia, probably originated in the fact that quinia was 
first fairly tried in the treatment of intermittent fevers, and having proved 
highly efficient in this disease, it naturally disinclined medical men to a full 
investigation of the medical properties of the remaining alkaline principle 
contained in bark. Unfortunately, too, the first essay with cinchonia did not 
fully realize the expectations of the observer, and its further use was, there- 
fore, for the time being, prematurely abandoned. In 1821, and soon after it 
had been fully discovered, by the labours of Pelletier and Caventou, that the 
febrifuge property of bark depended upon the presence both of quinia and 
cinchonia, a series of experiments were instituted by Chomel, with the view 
of ascertaining the comparative merits of these different substances in the 
treatment of intermittent fever. In his report to the Academy of Sciences, 
in Paris, he alludes to numerous instances in which the sulphate of quinia 
proved perfectly successful, but only refers to a single case as having been 
treated with the sulphate of cinchonia. This patient had been suffering with 
the disease for two months, in the quotidian form, and also had great enlarge- 
ment of the spleen; at first, only six grains of the cinchonia were administered 
during the apyrexia ; but, as this failed to check the disease, on the following 
day twenty grains were administered, with the effect of completely arresting 
the paroxysms. Upon reducing the dose, however, it appears that the patient 
soon relapsed, and was not permanently cured until twenty-four grains were 
given during the intermission. When we bear in mind that the above case 



1853.] Pepper, Beheerine and CincTionia in Intermittent Fever. 15 

had been of long duration, and was complicated with visceral enlargement, it 
is by no means surprising that the disease was not checked by small doses of 
cinchonia at the first effort, or that it should even have recurred after it had 
once been arrested by larger doses; for, under similar circumstances, it is 
well known that the same difficulties will often occur under the use of 
quinia, or any other treatment that may be instituted. And yet there is 
good reason to believe that the partial want of success in this single instance 
has had much to do in establishing the common opinion that cinchonia is less 
energetic than quinia, and consequently requires to be given in a stronger 
dose. 

A more thorough and impartial trial of this important remedy was, how- 
ever, made by Dr. Bally, in 1825. He gave the sulphate in twenty-seven 
cases of intermittent fever; and, although only six or eight grains were 
administered during the intermissions, he succeeded in promptly checking 
twenty-five of the cases, sixteen of which were of the tertian, and nine of the 
quotidian type, the average duration of the treatment being only four days. 
The remaining two cases were quartans, and these were checked quite as 
promptly as this most obstinate form generally is, by quinia or any other 
therapeutic agent ; in one instance the disease lasted only two days, and in 
the other it was permanently checked by the end of one week. From these 
observations, the above-named author concluded that the sulphate of cinchonia 
arrested acute paroxysmal affections with great promptitude, and that but a 
moderate dose was necessary for this result ; he also inferred that it was less 
irritating, and that it might, therefore, be more generally administered than 
the same salt of quinia ; he was even disposed to ascribe many of the cures 
usually attributed to this last-named substance to the well-known fact that it 
was no uncommon thing to adulterate quinia with cinchonia. In the Dic- 
tionnaire Universel de Matiere Medicale, par Merat et De Lens, allusion is 
made to numerous instances in which the cinchonia had been successfully 
used by French and Italian physicians ; amongst these may be mentioned 
Dufour, Petroz, Potier, Mariani, and Bleynie ; by all of whom it was fully 
shown that cinchonia was at least as efficacious as quinia. In confirmation of 
the same views, we also find it stated, in Christison's Dispensatory, that " pre- 
judice, together with the unquestionable energy of quinia as a remedy, has led 
to the other alkaloid, cinchonia, being overlooked in practice. The equally 
strong prepossessions, however, which were long entertained in favour of crown 
bark as a febrifuge and stomachic, though it contains but little quinia, or 
perhaps none at all, and the proofs which have been given of the great 
efficacy of the gray, or Huanuco bark, would justify the inference that cin- 
chonia, too, is eminently active. Accordingly, trials made with it by Dr. 
Bardsley, in England, as well as various practitioners of credit in France, 
Germany, and Italy, seem to leave little doubt that it is scarcely inferior to 
quinia in the treatment of intermittent, and some continental writers even 
maintain that, while equally energetic, it is likewise even less likely to dis- 



16 Pepper, Bebeerine and Cinchonia in Intermittent Fever. [Jan. 

order the stomach in large doses." In like manner, in the United States Dis- 
pensatory, Dr. Wood states : " There is little doubt, however, that cinchonia 
possesses febrifuge properties little, if at all, inferior to those of quinia ; and 
should the source of the latter begin to fail, the pale bark would come into 
more extensive use for the preparation of the former." 

In fifteen of the cases reported below, the cinchonia was administered with 
the most signal success, and fully confirmed the above statements as to its 
efficacy. In a majority of these, the disease had been of many months' dura- 
tion, and was attended with enlargement of the spleen, and more or less im- 
pairment of the general health ; yet, notwithstanding these serious difficulties, 
it was promptly checked at the first effort in eleven of the cases, and in two of 
these (XIV. and XVI.), the bebeerine had first been unsuccessfully tried. In 
only two instances (XII. and XIII.), was it necessary to administer the cincho- 
nia a second time for the arrest of the paroxysms ; and of the whole number, as 
far as it could be ascertained, but two relapsed (I. and V.), and these were 
promptly and permanently checked by again resorting to the cinchonia in full 
doses. In many of these cases, the quinia had been previously used with 
only temporary relief; but as no accurate account could be obtained from the 
patients either as to the doses or exact circumstances under which it had been 
administered, but little importance can be attached to this fact in estimating 
the comparative value of these two remedies. Judging from my experience 
in former seasons in similar cases, I am fully convinced that the cinchonia 
proved quite as efficacious as quinia, and occasionally, indeed, it appeared to 
be even more prompt. In no instance, that I am aware of, did it produce 
vomiting or other indications of gastric irritation; but when given in large 
doses, it gave rise to the same fulness of head as follows the use of quinia. 
In all the cases, the sulphate of cinchonia was given in solution with the addi- 
tion of a few drops of sulphuric acid ; my first impression was that it was 
more soluble than the same salt of quinia, but a more careful examination 
convinced me that such was not the case. In taste, the two salts appeared 
closely to resemble each other, but the cinchonia is, perhaps, the least bitter. 
It is to be regretted that, in some of the cases of intermittent fever, now about 
to be reported, the cinchonia had not been administered in smaller doses, with 
the view of ascertaining the minimum quantity by which the disease could be 
arrested ; having found, however, that in most instances of inveterate ague, 
at least sixteen grains of quinia were necessary to insure success, I was also 
induced to give this amount of cinchonia during the apyrexia in every case. 
In a previous part of this communication, it was stated that the same success 
had been obtained by Dr. Bally, from the use of only six or eight grains 
during the intermission ; and should these results be confirmed by future ob- 
servation, they will go far to show that cinchonia is not only equal to, but 
absolutely more potent than quinia. In several cases of neuralgia and inter- 
mittent fever which have fallen under my observation in private practice, the 
cinchonia has succeeded after the failure of quinia in similar doses ; but we 



1853.] Pepper, Bebeerine and Cinchonia in Intermittent Fever. 



17 



should be careful how we adopt this result as conclusive evidence of the supe- 
riority of the former remedy, since it is by no means improbable that the 
system may have been already more or less favourably impressed by the pre- 
vious use of the quinia; and it is for this reason that I am not even disposed 
to attach too much importance to the two instances above referred to, in which 
the cinchonia proved promptly successful after the failure of the sulphate of 
bebeerine in large doses. 

From the very full and satisfactory manner in which this subject has been 
investigated by previous observers, the present report may, by some, be con- 
sidered as a work of supererogation. But when we bear in mind that this 
remedy has scarcely been used in our country, and that, notwithstanding the 
above statements, many are still disposed to doubt its febrifuge power, it has 
appeared to the writer a matter of some importance that the attention of the 
profession should once more be invited to this subject. Not only is cinchonia 
an efficient remedy, but it derives additional importance from the fact that, at 
the present time, it can be supplied at far less than half the price of quinia. 
The poor are now in a measure debarred from the use of this last-named 
remedy, owing to its high cost; but this evil could, in a great degree, be 
obviated by the general introduction of cinchonia. The immediate effect 
would be a reduction in the price of quinia; but at the same time it is evi- 
dent that the increased demand for cinchonia, would necessarily enhance the 
value of this remedy — though it is hardly probable that either of these alka- 
loids would at any future time again command the high price now asked for 
quinia. 

Case I. — G. W., seaman, aged thirty-three years, entered the hospital on 
the 12th of March, suffering with intermittent fever. From his statement, it 
appears he had contracted his disease at Chagres last September, from which 
time, up to the present, he has had repeated attacks in the tertian form. His 
present attack commenced about five days before his admission, and had now 
assumed the quotidian type, the paroxysm commencing generally between the 
hours of ten and twelve in the morning. The spleen was much enlarged, 
skin slightly icterode, and, at the same time, he was exceedingly anaemic. 

Two grains of the sulphate of cinchonia were administered in the evening, 
and the same dose was to be repeated the following morning every two hours 
until he had taken sixteen grains. On the 13th, however, the chill com- 
menced much earlier than usual, and before the patient had taken a second 
dose, so that the medicine had to be discontinued. By midday, the fever had 
subsided, and the cinchonia was resumed, one grain every hour to the above- 
named amount. From this time up to the 21th he had no return of the dis- 
ease, and, during this period, he used two grains of the cinchonia with five of 
Vallet's carbonate of iron three times a day; strong iodine ointment was also 
applied over the spleen. During the afternoon of this day, he experienced a 
slight chilly sensation followed by considerable perspiration; from this time 
he remained well, up to April 5th, when he again had the same train of 
symptoms, and these continued to recur for several consecutive days at about 

ii a. m. 

Thursday, April 7, or just four weeks from the time of his admission, he 
had a decided chill, followed by fever and perspiration ; accordingly, on the 



18 Pepper, Bebeerine and Cinchonia in Intermittent Fever. [Jan. 



following morning at 6 o'clock, he commenced taking two grains of cinchonia 
to be continued for eight consecutive hours. From this time, he had no re- 
turn of his chill, but, as a precautional measure, two grains of the cinchonia, - 
and five of pil. carb. ferri. were continued three times a day, during his stay in 
the house. He left the institution on the 12th, apparently perfectly well, his 
colour having greatly improved, and the spleen being reduced to nearly its 
natural dimensions, 

In the above case, it will be perceived that, although the disease was 
promptly arrested by the administration of sixteen grains of cinchonia, it re- 
turned ten days after in an exceedingly mild and modified form; this was 
again followed by an interval of the same duration, but the paroxysms were 
not permanently checked until sixteen grains were once more given during 
the apyrexia. When, however, we consider the long duration of the disease, 
the patient's anaemic condition, and the great enlargement of the spleen, 
which complicated the case, there is certainly no reason to be dissatisfied with 
the effects of the remedy. A more successful result could not probably have 
been attained from quinia under existing circumstances. 

Case II. — J. D., seaman, aged twenty-three, entered hospital April 17, 
labouring under quotidian fever of two months' duration, states that he con- 
tracted the disease at Chagres, and that he had upon several occasions taken 
quinia without relief; he could not, however, specify the exact amount of this 
medicine which had been administered. His skin was now sallow, lips pale, 
and the spleen much enlarged and painful on pressure. Upon the day of his 
admission he had a severe chill, followed by fever, lasting five hours, and 
ending in copious perspiration. The paroxysm commenced at about ten in 
the morning, and the same evening he took sulph. cinchonas grs. ii, every two 
hours, for four consecutive doses; the same treatment was resumed early on 
the morning of the following day, until he had taken in all grs. xvj. From 
this time he had no return of the disease, and was now directed to take five 
grains of Vallet's ferruginous mass with two grains of the cinchonia three 
times a day. Under this treatment his complexion rapidly improved ; by the 
10th of the following month, the spleen was reduced to its natural size, and he 
now left the hospital apparently in perfect health. 

In this instance, the cinchonia was so signally efficacious that further com- 
ment is unnecessary. 

Case III. — R. C, seaman, aged thirty-five, entered the hospital on the 19th 
of March; stated that he had contracted intermittent fever at Mobile, and that 
he had now been suffering with this disease in the tertian form for the last 
two months, the paroxysms generally commencing about 11 A. M. On the 
day of his admission, he had a severe and protracted chill at about seven in 
the morning, followed by high fever and ending in copious perspiration. On 
the 21st, the paroxysm commenced about 4 A. M., and it was, therefore, 
deemed expedient in anticipation of the next attack to commence with the 
cinchonia on the following morning; two grains to be administered every two 
hours until he should have taken, in all, sixteen. 

On the 23d, the day of the expected paroxysm, the patient remained per- 
fectly well, and so continued up to the 9th of the following month, April, 
when he left the hospital to all appearances in full health. After the arrest 



1853.] Pepper, Bebeerine and Cinchonia in Intermittent Fever. 



19 



of the paroxysms, as in the former cases, he was kept steadily upon the use of 
cinchonia and Yallet's carbonate of iron, two grains of the former and five of 
the latter, three times a day. 

In this instance, the disease had been of short duration, and, being unat- 
tended by any enlargement of the spleen, or serious disorder of health, was, 
of course, more amenable to treatment. 

Case IY. — ST. D., labourer, aged thirty, admitted April 17, for intermit- 
tent fever of the quotidian type. He contracted the disease about eighteen 
months ago in the State of New Jersey; during the past winter, however, he 
had been free from it, and it only reappeared about one week before his ad- 
mission, the paroxysms coming on daily about 8 A. M. His complexion was 
a little sallow, but no enlargement of the spleen could be detected, nor had 
his general health suffered much. On the evening of the 17th, he took grs. 
ij of sulph. cinchonia every two hours for four consecutive doses, and this 
same plan was pursued the following day, so that, by ten o'clock on the morn- 
ing of the 18th, he had taken, in all, grs. xvi. 

From this time he remained perfectly well, but to guard against a relapse, 
he was directed two grains of cinchonia with five of the iron three times a day 
during his stay in the house. By request, he left the institution on the 27th 
of the same month in excellent health. 

Case V. — E. M., a young woman, aged twenty-five, entered the hospital 
April 26th, suffering with intermittent fever, stated that she had been residing 
in the city for the last eighteen months, and that upon no previous occasion 
had she been subject to ague ; her present attack was only of four days' dura- 
tion, the paroxysms generally coming on in the forenoon. Xo visceral en- 
largement could be detected, nor was her constitution materially impaired, 
though, at the same time, she was naturally nervous and more or less pallid. 
On the day after her admission, the chill recurred as usual, and she was 
accordingly directed to take grs. ij sulph. cinchonia every two hours, com- 
mencing at 2 P. M., and continuing the treatment up to bedtime; the follow- 
ing morning, April 28th, the same plan was to be pursued until, in all, grs. 
xvi had been taken. From this date, she had no return of the disease; but, 
during her stay in the house, she took, three times a day, grs. ii of sulph. 
cinchonia, and grs. v of pil. ferri. carb. On the 16th of May, or about three 
weeks after her admission, she was discharged perfectly well. 

She was readmitted May 24 th, and stated that the disease had returned on 
the third day after her discharge, and had now assumed the tertian form ; the 
paroxysms commencing about 5 A. M. Her bowels being constipated, five 
grains of blue pill were directed in the evening, to be followed in the morning 
by a Seidlitz powder; on the 26th and 28th, the chill commenced at about 
the hour above indicated, no antiperiodic" having been administered up to this 
time. On the evening of the 29th, she took eight grains of the cinchonia 
before bedtime in two-grain doses, and at an interval of two hours; on the 
following morning, eight grains more were in like manner administered in 
anticipation of the expected paroxysm. There was, however, no return of 
the disease up to 13th of June, about which time she left the institution ap- 
parently perfectly well. It should also be stated that, from the time of the 
last paroxysm up to the period of her discharge, the sulph. cinchonia and iron 
were continued in small doses three times a day, as in the former cases. 

It has long been remarked by careful observers that there is a tendency in 



20 Pepper, Bebeerine and Cinchonia in Intermittent Fever. [Jan. 



intermittent fever, when checked by whatever means, to recur on the four- 
teenth or twenty-first day after the last paroxysm; in the above case, it will 
be perceived that a relapse took place two or three days after leaving the hos- 
pital, or just three weeks from the occurrence of the last attack, and was, 
most probably, owing to some indiscretion on the part of the patient. 

Case VI. — J. L., seaman, entered the hospital April 17, for intermittent 
fever; stated that he had contracted the disease in North Carolina last autumn, 
and that it then persisted for eight weeks, but had not recurred during the 
past winter. The first paroxysm this spring occurred two days previous to 
his admission, and was renewed on the 17th and 19th ; on the evening of the 
21st, eight grains of sulph. cinchonia were administered, and the same amount 
on the following morning before nine o'clock. By this treatment, the dis- 
ease was promptly checked, and did not return up to April 27th, when he 
left the hospital perfectly well. During his stay in the house, however, he 
was kept under the use of sulph. cinchonia grs. ii, and pil. carb. ferri three 
times a day. It may also be important to state that in this case there was 
no enlargement of the spleen, or any serious constitutional disturbance. As 
he had left the institution rather prematurely, he was requested to return in 
case of relapse ; but not having been heard of up to the end of June, the pre- 
sumption is that the cure was permanent. 

Case VII. — J. W., labourer, admitted May 8, for intermittent fever, 
under which he had been suffering since last July. During the winter, the 
attacks were irregular, both in form and duration ; but, for four days previous 
to admission, the paroxysms had come on every afternoon, preceded, however, 
with but slight chilliness. Upon several occasions he had used quinia with 
temporary relief, but his health was now much impaired; lips pallid; skin 
slightly icterode; spleen greatly enlarged. 

On the 9th, about 4 P. M., he was seized with a severe chill followed by 
high fever, and ending in profuse perspiration; during the same evening and 
following morning, sixteen grains of sulph. cinchonia were used, grs. ii being 
given every two hours. 

On the 11th, he escaped his chill, and continued perfectly well up to May 
27; by this time, his colour was restored; the spleen had regained its natural 
dimensions, and, in fact, his health appeared fully re-established. He was, 
accordingly, discharged, with the full understanding that the sulph. cinchonia, 
grs. ii, and pil. ferri. carb., which he had been taking three times a day since 
in the house, should still be continued for some days ; he was also requested 
to return in case of relapse, but as nothing was heard from him up to the end 
of J une, it is highly probable that the cure was permanent. 

Case VIII. — H. B., labourer, aged twenty-five, admitted on the 18th of 
May, for intermittent fever; he stated that, for the last four days, he had 
been subject to irregular chills and fevers; the skin was not icterode, nor was 
there any enlargement of the spleen. At the time of his admission, he was 
suffering with fever, for which he took the neutral mixture; on the following 
day, however, he appeared perfectly well. On the 20th (two days after ad- 
mission), he had a severe chill about 7 A. M., and, in the course of the same 
day, another paroxysm, but much milder than the first. On the following 
day, there was no return of the disease, but, on the 22d, or fourth day after 
admission, he had a heavy chill about daylight, and another, equally severe, 
three hours after, followed by high fever and copious perspiration. 



1853.] Pepper, Bebeerine and CincJionia in Intermittent Fever. 



21 



23c?. Being free from fever to-day, he commenced with the sulphate of 
cinchonia at 3 P. M., and took two grains every hour up to ten at night. 
After this, there was no return, and, as usual, he was directed two grains of 
cinchonia with five of iron three times a day. On the 28th, he was discharged 
on account of the crowded condition of the wards, but was particularly charged 
to continue the above treatment for two weeks, and, at the end of this time, 
to return and report his condition. Accordingly, he came to the hospital on 
the 8th of June, and stated that he had remained perfectly well since leaving 
the institution. 

From the confused account given by the patient of his previous symptoms, 
it at first was no easy matter to decide upon the type of his disease; as, how- 
ever, he had two distinct chills upon alternate days, it became evident that he 
was labouring under a duplicated or doubled tertian. 

Case IX. — D. B., labourer, entered the hospital April 21 ; stated that he 
contracted the disease last autumn in Maryland, and that he suffered repeated 
attacks of intermittent fever in the tertian form during the past winter; seven 
days previous to his admission, however, the paroxysms came on every even- 
ing. The spleen was perceptibly enlarged, and his countenance was pallid 
and somewhat sallow. 

On the 22d and 23d, he had a severe chill about 8 P. M. j and, accord- 
ingly, on the following day, 24th, he took cinchonia sulphat. grs. ii every 
hour from 3 P. M. to 7 P. M. He had no further attack from this date, and 
under the use of small doses of cinchonia and iron, soon regained a healthy 
appearance, whilst at the same time the spleen was rapidly reduced in size. 

Owing to the crowded state of the wards, he was obliged to leave on the 
28th of same month; he, however, was supplied with iron and cinchonia suf- 
ficient for two weeks, with the full understanding that he should return in 
case of relapse. Not having heard from the patient up to the end of June, 
it is highly probable that his recovery was permanent. It is worthy of re- 
mark, in connection with this case, that the disease, though of long duration, 
and attended with considerable disorder of health, and much enlargement of 
the spleen, was, nevertheless, promptly checked by ten grains of the sulphate 
of cinchonia. 

Case X. — TV. J., seaman, admitted May 29, for intermittent fever. The 
disease was contracted last summer at New Orleans; he there had it in the 
tertian form for four or five weeks, and it again returned in the autumn ; but 
during the winter, though not well, he had no decided chill or paroxysm. 
This spring it returned towards the end of April, and has since recurred every 
other day in the morning, between the hours of eleven and twelve. At the 
time of his admission the skin was slightly icterode, and the spleen somewhat 
enlarged. 

On the day after his admission the chill came on as usual at about 12 31. ; 
and, accordingly, in anticipation of the next paroxysm, on the 1st of June he 
was directed two grains of the sulphate of cinchonia every hour from 4 A. M. 
to 11 A. M. There being no return of the disease, from this date he was 
ordered two grains of the cinchonia and five of the iron three times a day ; 
this treatment was continued for two weeks, when he left the institution ap- 
parently in full health. 

Case XI. — J. W., German labourer, entered the hospital, May 28, for 
intermittent fever. He contracted the disease last August in New Jersey, 
but had no return until the end of March ensuing; since then, however, the 



22 Pepper, Bebeerine and Ginchonia in Intermittent Fever. [Jan. 



paroxysms have come on daily at about 2 P. M. At the time of admission, 
his face was pallid and bloated, and the spleen greatly enlarged. 

On the day of admission he had a severe chill at 7 P. M.; and, on the foL- 
lowing day, it came on at the usual hour, about 2 P. M. On the 30th, he 
commenced with two grains of sulph. cinchonia every hour from 6 A. M. to 
2 P. M. inclusive; but it failed to check the disease, and the chill came on as 
usual soon after taking the last dose. On the 81st, he took the same quanti- 
ties at the same hours, and from this time had no further return. Daring 
his stay in the house, strong iodine ointment was freely applied over the region 
of the spleen, and, at the same time, two grains of the cinchonia and five 
of iron were regularly administered three times a day. On the 12th of the 
month following, June, he left the institution greatly improved in health; 
the spleen also having nearly regained its natural size. 

Case XII. — A. K., labourer, aged twenty-one, entered on the 2d of June, 
for intermittent fever. He had been suffering with the disease for one 
month, at first in the quotidian, and then in the tertian form. At time of 
admission he was pale and sallow, and had considerable enlargement of the 
spleen, which was also tender on pressure. 

On the day following, he had a severe chill in the course of the morning, 
and accordingly on the 4th he commenced with the cinchonia, taking two 
grains at 6 P. M., and the same dose at bedtime; on the following morning 
the same treatment was resumed at 4 A. M. ; and continued every hour up 
to 9 A. M., making in all sixteen grains. 

Soon after the last dose had been administered, however, the chill came on 
and was followed by fever, which lasted until evening. June 6, being his 
well day, he took but six grains of the cinchonia in the course of the twenty- 
four hours. In anticipation of the paroxysm on the 7th, it was determined 
to give the cinchonia in larger doses, and nearer to the usual time of the 
paroxysm ; accordingly, he took four grains at five, six, eight, and nine 
o'clock in the morning. From this time the disease was checked, and did 
not return up to the 19 th, when he left the hospital much improved in health, 
the spleen also being reduced to its natural size. 

Case XIII. — J. W., seaman, aged twenty-six, admitted June 18, for 
intermittent fever. The disease had been contracted at New Orleans, in the 
early part of this month ; he then had a paroxysm for four or five conse- 
cutive days, which speedily yielded to sulphate of quinia, and did not again 
recur until the 25th, or about one week after entering the hospital. At the 
time of admission, there was some sallowness of skin, and slight enlargement 
of the spleen; the patient also suffered with great prostration, and it was 
especially for this distressing symptom that he sought medical aid. He was 
accordingly directed full diet and a bottle of porter; also two drachms of the 
compound tincture of gentian three times a day. 

About 1 P. M., on the 25th, as above stated, he had a severe chill followed 
by fever and perspiration ; on the following day, sixteen grains of the sul- 
phate of cinchonia were prescribed in two-grain doses in anticipation of an 
expected paroxysm. At 3 P. M., however, the chill returned with equal 
violence. 

On the 27th, he again took the same amount of cinchonia, commencing 
about 8 A. M., and taking two grains every hour up to 3 P. M. The cin- 
chonia this time proved perfectly successful, and there was no further return 
of the disease up to July 9, when he left the hospital apparently in perfect 



1853.] Pepper, Beheerine and Cinchonia in Intermittent Fever. 23 

health. During his stay in the house, the cinchonia and iron were daily 
administered in two and five grain doses as in all the previous cases. 

It is to be regretted that in this, as well as in several of the other cases 
above reported, the patients could not be kept sufficiently long under observa- 
tion to ascertain fully the durability of the cure. In every instance, how- 
ever, where the discharge took place within two or three weeks after an arrest 
of the paroxysms, strict injunctions were given to return in case of relapse ; 
and as nothing to the contrary was heard from these patients, it is fair to 
conclude that the cures were most probably more or less permanent. 

In the four following cases, the bebeerine was given in place of the cin- 
chonia, with the view of testing their comparative merits in the treatment of 
intermittent fever. 

Case XIV. — J. H., seamstress, aged nineteen, admitted June 5, had 
suffered last summer and autumn with intermittent fever, which she contracted 
whilst residing in New Jersey. The paroxysms had been repeatedly checked 
by quinia, but invariably returned at the end of a week ; during the winter, 
however, she remained free from them, but did not feel well, and always 
complained of pain in the region of the spleen. In March, the disease again 
returned, sometimes assuming the tertian, and at others the quotidian type ; 
under the use of quinia, she again improved, but the disease was not eradi- 
cated, and she continued to have her good and bad days up to the time of 
admission. At this time she was pallid, and had considerable enlargement of 
the spleen. 

June 5, at 9 A. M., she had a severe chill, followed by fever and per- 
spiration ; another paroxysm occurred on the 7th, at about inidday. In 
anticipation of the chill on the 9th, two grains of the sulphate of bebeerine 
were administered at 5 A. M., and to be repeated every hour until she had 
taken sixteen grains. The paroxysms did not return, and the patient was so 
well pleased with the result that, contrary to orders, and unknown to the 
nurse, she continued the medicine in four-grain doses, from 12 M. up to 5 
P. M., making in all some forty grains that she had taken in the course of 
the day. The only effect from the bebeerine in these large doses was sickness 
of stomach, unattended, however, by headache, giddiness, or ringing in the 
ear, such as generally follows the use of quinia in similar doses. 

Although the bebeerine and iron (two grains of the former and five of the 
latter) were continued three times a day, the disease recurred on the loth. 
Accordingly, on the 15th, the bebeerine was again prescribed every hour, 
from 5 A. M. up to 12 M. inclusive. Immediately after the last dose, how- 
ever, the chill came on, and was followed by high fever and severe headache. 
A paroxysm of equal severity came on at 12 M., on the 17th, showing clearly 
that the disease was in no manner influenced by the treatment. Accordingly 
on the 19th, it was determined to substitute the cinchonia in two-grain doses 
every hour, from 6 A. M. to 10 A. M. inclusive, making in all ten grains, 
during the apyrexia. 

From this time there was no return of the disease up to the 30th, when she 
left the house in perfect health, having regained her flesh, strength, and 
colour, and the spleen being reduced to its natural dimensions. As in the 
former cases, from the time of the arrest of the paroxysms, she had taken, 
during her stay in the house, two grains of the sulphate of cinchonia, with 
five grains of Vallet's carbonate of iron, three times a day. 



24 Pepper, Bebeerine and Cinchonia in Intermittent Fever. [Jan. 



Case XV. — M. H., domestic, aged twenty-seven, admitted June 8, for 
intermittent fever, which commenced about one month ago. The disease was 
then checked by the use of Peruvian bark, but it soon returned, and for two 
weeks previous to admission she had a paroxysm every day at about 7 P. M. 
Her general health was not much impaired, but the spleen was somewhat 
enlarged. On the day of admission, the chill came on as usual in the evening, 
and accordingly on the following day in anticipation of its return, she took 
two grains of the sulphate of bebeerine every hour from 11 A. M. to 6 P. M. 
inclusive. From this time, the disease was checked, and on the following 
day, two grains of the bebeerine, with five of iron, were given three times a 
day during her stay in the hospital. She was discharged in full health on 
the 25th, not having had a return since the 8th. In this instance, the 
bebeerine did not excite vomiting, as in the former case, but it produced some 
acceleration of the circulation, the pulse having risen from 78 to 100. 

Case XVI. — H. P., seaman, aged twenty-six, admitted June 9, for 
intermittent fever. The disease had been contracted at Panama, four months 
ago, since when it has continued to recur at irregular intervals ; upon several 
occasions, quinia had been taken in large doses, but only with the effect of 
suspending the paroxysms for a few days. For one week previous to admis- 
sion, he has had a return every day at about 4 P. M., aud was now icterode, 
and had great enlargement and induration of the spleen. 

On the 10th, the bebeerine was ordered in two-grain doses every hour, 
from 8 A. M. up to 4 P. M. ; by this treatment, though the disease was not 
checked, the paroxysm was postponed until 6 P. M., and was much less severe 
than on former occasions. On the 11th, the same plan was pursued as on 
the previous day • this time, however, with the effect of completely arresting 
the disease for the space of one week, or up to the 19 th, when he had a 
relapse, the paroxysm coming on at about 2 P. M. 

Two days after, or on the 21st, the chill returned at about the same hour, 
showing clearly that the disease had now assumed the tertian type. Up to 
this time, he had continued the bebeerine and iron (two grains of the former 
and five of the latter three times a day) ; as this treatment appeared only to 
modify the disease without checking it, it was determined to substitute the 
sulphate of cinchonia as in the former cases. Accordingly on the 23d, two 
grains of it were administered every hour from 8 A. 31. to 1 P. M., making 
in all only twelve grains. The only result was a postponement of the parox- 
ysm until 4 P. M'.j or two hours later than the previous chill. The next day, 
however, the cinchonia was administered in like manner, and from this time 
there was no return up to July 9, or a period of more than two weeks, 
since the last attack. He was now discharged at his own request, and left 
the hospital apparently in perfect health. 

Case XVII. — J. W., seaman, aged twenty-one, admitted June 10, 
labouring under a paroxysm of intermittent fever. The disease had been 
contracted last autumn in Savannah, and has continued to recur at irregular 
intervals up to the present time. The chill generally recurred on alternate 
days, at about 11 A. M. ; his health was much impaired, skin icterode, 
spleen much enlarged and indurated. 

On the 12th, the attack came on at the usual time, and was followed by 
severe fever, which lasted three hours. In anticipation of the next paroxysm, 
he was ordered, on the 13th, two grains of the bebeerine every hour from 6 
P. M. to 9 P. M., and the same to be resumed on the following morning at 



1853.] 



Porter, Surgical Notes of the Mexican War. 



25 



6 A. M. and continued up to 9 A. M., making in all sixteen grains during 
the apyrexia. From this time there was no return, and under the use of 
small doses of bebeerine and iron, his health continued gradually to improve ; 
on the 30th, he was discharged, not having had a chill for the last eighteen 
days, and his spleen being reduced to its natural size. 

In conclusion, I would state that the above trials with cinchonia were 
instituted at the suggestion of Dr. Carson, and that I have been much aided in 
the undertaking by the valuable notes furnished by Dr. A. Hewson, Kesident 
Physician. 



Art. II. — Medical and Surgical Notes of Campaigns in the War with 
Mexico, during the years 1845, 1846, 1847, and 1848. By John B. 
Porter, M. D., Surgeon U. S. Army. (Continued from Yol. XXIY. 
p. 30.) 

Treatment of Gunshot Wounds, continued. — When a musket ball has passed 
through a fleshy part, the wound may be dressed with a little lint, adhesive 
plaster, and a few turns of a roller, and afterwards the cold-water dressing, or 
lead lotion, both excellent, may be applied. The cold lead- water poultice, 
after the wounded are placed in hospital, so light as not to cause pain or 
uneasiness by its weight, is a good application, and does not require such fre- 
quent renewals as the lotion — a consideration, when every hospital attendant 
has as much duty to perform as he can turn his hand to. In the first part of 
the treatment, both Guthrie and Hennen strongly advise cold applications ; 
but if they affect the patient unpleasantly or the wound become stiff and pain- 
ful, warm ones must be substituted; and poultices are the best, as being more 
durable in their influence than fomentations. When the bone of a limb is 
injured, and amputation is not considered necessary, much the same treat- 
ment is advisable, after removing splinters and foreign bodies. The effect 
of cold applications should be carefully watched, and the too long continuance 
of poultices in the subsequent stage avoided. It is never expected that a gun- 
shot wound, however simple, will heal by the first intention ; nor is it expected 
that a wound of this character can, by the use of cold dressings, or by any 
treatment whatever, be prevented from suppurating to some extent • but great 
good may be accomplished by cold dressings in the first part of the treat- 
ment, by preventing extensive cellular inflammation and consequent profuse 
suppuration. Suppuration and Roughing are always expected to occur, more 
or less, in all gunshot wounds, particularly at the entrance and exit of the 
ball, but it by no means follows that sloughing will inevitably take place in 
the whole track of the bullet; and a free use of cold dressings may do much 
to prevent extensive inflammation, deep sloughing, and profuse suppuration. 
Mr. G-uthrie says : — 



26 



Porter, Surgical JS r otes of the Mexican War. 



[Jan. 



" An idea is entertained by some, that the whole track of a gunshot wound 
must suppurate, and a slough of dead matter be thrown off ; but this is an 
erroneous opinion/' 

In all gunshot wounds, whether simply through the flesh, or with injury 
of the bone, whenever the part becomes stiff and painful, poultices for a short 
period are beneficial. 

Mr. Guthrie, very properly, is a strong advocate for the employment of 
cold water in gunshot wounds ; nor is he so much opposed to the use of poul- 
tices as at first view might appear, but only to their abuse. 

" Cold water is," he says, " in my opinion, the- proper application to gunshot 
wounds in persons of a healthy habit of body ; it may be applied in many peo- 
ple during the whole progress of the cure with the best effect ; and when it is 
admissible, it ought to be constantly used, unless in those cases in which sim- 
ple compress and bandage may be considered sufficient. Cold water is not, 
however, an infallible, or even always an advantageous remedy ; there are 
many persons with whom cold applications do not agree ; there .are more with 
whom they disagree after a certain period, and in either case they should not 
be persisted in. Cold does no good in any stage of inflammation when the sen- 
sation occurring from the first application of it is not agreeable to the feelings 
of the patient; when, in fact, it does not give relief; for if it produce a sensa- 
tion of shivering, or an uncomfortable feeling of any kind, with stiffness of the 
part, it is doing harm ; and a change to the genial sensation of warmth will 
not only prove more agreeable but more advantageous. This occurs in general 
about the period when suppuration has taken place ; and cold in such cases is 
preventing the full extent of the action which warmth encourages. Fomenta- 
tion^ are then proper ; and if a poultice be preferred for convenience by day or 
by night, an evaporating one of bread will be found sufficient. In the spring 
of the year, the marshmallow makes an excellent poultice, and so do turnips, 
gourds, carrots, &c, independently of oatmeal, linseed meal, Indian meal, or 
other farinaceous substances." — Gunshot Wounds, p. 66. 

In Mexico, we had linseed meal, generally corn meal ; a good poultice could 
always be prepared from the bark of the slippery elm (ulmus fulva), of which 
we had a supply; and the leaf of the prickly-pear (cactus opuntia), growing 
abundantly in all parts of Mexico, is also easily made into an excellent poul- 
tice. 

Bandages are exceedingly useful in the treatment of gunshot wounds, but 
it is not advisable to apply them too soon. 

" Rollers ought not to be applied surgically until some days have elapsed, 
and it is inexpedient to employ them in the field of battle, even if they were 
useful, except where some parts are to be kept in position ; because when they 
are employed in the first instance, they soon become stiff and bloody, are for 
the most part cut, and are seldom preserved after the first dressing, so as to 
become useful at the period when the surgical application of a roller is 
indispensable." — Guthrie. 

In gunshot wounds, through the thigh especially, after a few days have 
elapsed, rollers are very useful ; and at a fater period, when the limb, both 
from local and general irritation, has become emaciated, the muscles hanging 
almost like so many strings from the bone, the roller is of incalculable bene- 
fit, by supporting the muscles, and bringing the sides of the wound in the 
track of the ball into close contact. 



1853.] 



Porter, Surgical Notes of the Mexican War. 



27 



Fracture from Gunshot. — Mr. G-uthrie says : — 

" The surgery of the campaign of Waterloo was not the same with the sur- 
gery of the Peninsula. You will naturally ask me why it was not? and the 
answer is a very simple one: that they were not the same people, or when they 
were the same, the ablest had marched with the army to Paris, or were solely 
engaged with the wounded officers. The hospitals were principally in charge 
of others who had served but little on the field of battle, and it was the 
wounded under their care that were open to remark. One instance will suffice 
to explain my meaning. After the last battle in the Peninsula, no one on the 
third day could have found a gunshot fracture of the thigh in the bent position 
on the side ; after the battle of Waterloo no person could have found one in 
any other. * * * The position of a fractured femur must be essentially of 
one kind, viz., straight; for it is impossible to keep a man's thigh in the bent 
position on the side, and himself in the same situation. No power that is 
likely to be employed can prevent his turning on his back, and the union, if 
it takes place at all, must then be at an angle." — Clin. Lectures, pp. 16 and 52. 
"It must be borne in mind, that all compound fractures of the thigh should be 
placed in the straight position, and if possible, from the moment of injury/' — 
Gunshot Wounds, p. 378. 

We have here another instance of practice in obedience to the law of 
authority. In obedience to the precepts of Mr. Pott, it appears that the Eng- 
lish surgeons, for many a campaign, placed patients with compound fracture 
of the thigh on the side, and the practice was not finally exploded until the 
last of the campaigns in the Peninsula. The natural position of a patient 
who is badly injured or badly diseased is on his back, nor can he be made to 
remain on his side. If a patient with a compound fracture of the femur be 
placed on his side, the consequence will be that, before the expiration of the 
twenty-four hours, he will turn on his back, or partially turn, and his body 
will be in one direction and his foot in another. In every serious disease, whe- 
ther it be fracture or fever, the natural position is on the back j and it is of 
little use to try to keep the patient on his side. The permanent position on 
the side is one of the most painful to which a patient can be subjected. The 
patient being on his back, " the bent position forwards, or on an inclined 
plane, is defective." ( Guthrie, -Clin. Lectures, p. 52.) And the best position in 
gunshot fractures of the femur, all things considered, is on the back with the 
limb extended. 

Dilatation or scarification (debridement) of gunshot wounds is common in 
the French service. Mr. Hennen says : — 

" There still prevails among foreign surgeons, and particularly the French, 
a strong prejudice in favour of the immediate scarifications or dilatations of all 
gunshot wounds." — p. 60. " The practice during the Peninsular War was, 
never to dilate without a precise object in view, which might render an addi- 
tional opening necessary." — Guthrie, Gunshot Wounds, p. 82. "The indiscri- 
minate dilatation of all gunshot wounds, without a distinct and specific object 
in view, is now very justly abandoned." — Sir G. Balling all, Outlines Mil. Surg. 
p. 219. 

Mr. Alcock states, that all the wounded Spaniards who fell into the hands 
of the French surgeons after the assault of Irun were " unmercifully estrel- 
lated by the French bistoury." These few extracts serve to show the views 
and practice of English military surgeons. 



28 



Porter, Surgical Notes of the Mexican War. 



[Jan. 



" The question of dilating wounds with the knife seems to be disputed at 
present in France with as much keenness as it was in the days of J. Bell and 
Hunter in our own country ; and the impropriety of making precautionary 
incisions, or indeed incisions of any kind, save for the removal of foreign 
bodies, or the securing of vessels, is anything but generally admitted, although 
strongly enforced by M. Baudens." — Med.-Chir. Rev. Oct. "l848, p. 547. " M. 
Jobert objects to the dilatation of wounds." * * * " M. Begin, on the other 
hand, approves of the preventive debridement, or dilatation of wounds, and he 
thinks it is necessary in gunshot wounds, simply because they are gunshot 
wounds, at least in all such as are deeply seated, or are covered by strong 
aponeuroses." — Med.-Chir. Rev. January, 1849, pp. 271, 272. 

M. Baudens, chief surgeon to the French army in Algeria, decidedly con- 
demns the preventive debridement: 11 Le debridement preventif des plaies 
d'armes a, feu est toujours nuisihle." The knife may be required to remove 
foreign bodies, to secure bleeding vessels, to divide tense fasciae, and evacuate 
deep-seated matter, and to relieve engorgement of the vessels. I would 
recommend, in all cases, that a ball or other foreign body be at once removed, 
if it can be felt, no matter how deeply it may be situated. 

Hemorrhage from Gunshot Wounds — primary and secondary. — On this 
question the highest authorities are at variance. Hennen says : — 

"And here I must entreat the young army surgeon not to allow himself to 
be lulled into a fatal security, by a supposition that secondary bleedings from 
gunshot wounds are of but imaginary importance, and of rare occurrence. The 
supposition is absolutely erroneous/' — Mil. Surg. p. 150. 

S. Cooper, Surg. Diet., says : — 

"As the ends of the torn vessels are contused and compressed, gunshot 
wounds have at first less propensity to bleed seriously than most other wounds, 
unless vessels of importance happen to be injured. In the beginning there 
may even be little hemorrhage, though a considerable artery be so hurt that it 
afterwards sloughs, and a dangerous or fatal bleeding arises. * * About a 
week after the battle of Waterloo, the cases of hemorrhage on the loosening of 
the sloughs were tolerably numerous; not at all coinciding with a recent cal- 
culation that the proportion of such examples, requiring the ligature of arte- 
ries, is only three or four in a thousand. [Guthrie.) In Holland, the truth of 
Mr. Hunter's observation upon this point appeared to me to be completely con- 
firmed." 

On the other band, Mr. G-uthrie, second to no one in military surgery, 
says :— 

"I have proved from official documents, that the great dread entertained of 
secondary hemorrhage in gunshot wounds was groundless." — Preface to Gun- 
shot Wounds. " The erroneous idea which has pervaded alike medical books 
and the minds of medical men, that gunshot wounds do not bleed unless great 
arteries are wounded, has arisen from generalizing too much." — Gunshot 
Wounds, p. 5. "The distinctions usually made, that gunshot wounds do not 
bleed at the moment of injury, unless a large artery be Avounded, and that they 
do generally bleed, and often profusely, after suppuration has taken place, can- 
not be too soon banished from the mind of every surgeon, as they lead to very 
bad practice, and give much unnecessary trouble; for instead of waiting with 
the greatest anxiety for hemorrhages, when the sloughs separate from wounds 
in the vicinity of great arteries, the surgeon may think himself peculiarly 
unfortunate if he meets with a greater proportion of cases than I have men- 
tioned."—/^, p. 10. 



1853.] Porter, Surgical Notes of the Mexican War. 29 

Sir G-eorge Ballingall states, that 

" The proportion of cases requiring the ligature of arteries from secondary 
hemorrhage is stated by Mr. Guthrie, I believe, with great truth, not to exceed 
three or four in a thousand, exclusive of hemorrhage from hospital gangrene, 
inordinate sloughing, or broken bones." — Outlines of Mil. Surg. p. 325. 

On the first point, "that gunshot wounds do not bleed unless great arteries 
are wounded," I apprehend that Mr. Guthrie is right, for I have seen a good 
many cases of gunshot wounds, where the hemorrhage was profuse, there being 
no large artery injured. And, in regard to the second point — "cases of 
hemorrhage on the loosening of the sloughs" — so far as my own experience 
goes, Mr. Guthrie is entirely in the right, for I have never seen a case of 
hemorrhage after the separation of the slough. 

Not a single case of hospital gangrene, tetanus, or secondary hemorrhage 
was seen by the writer during the war with Mexico.* 

Bayonet and lance wounds were not common in Mexico. The brilliant 
charges of opposing columns in battle are almost always charges on paper. 

" Although much has been written, and more stories have been told (indeed, 
so often told that the people who relate actually at last believe them), about 
charging with the bayonet, their crossing and locking, the heroic efforts made 
by the parties, and so forth, that it might be supposed these wounds were of 
frequent occurrence; the fact is, however, otherwise." — Guthrie. 

" A punctured wound made with a lance or bayonet," says Mr. Guthrie, 
"is always a contused wound. "j" 

* In 1843, a man had the whole hand and wrist so shattered, by the premature dis- 
charge of a cannon, that amputation of the forearm was necessary ; which was done 
by the circular incision. Not a single artery could be found, excepting one of the 
interosseous. After remaining open awhile, the stump was carefully dressed, as in 
the regular operation, and a close watch was kept over the patient until all danger 
from hemorrhage had ceased. No accident occurred in the progress of the case, and 
the man recovered, although the whole arm and the side of the thorax were severely 
burned at the time of the explosion. 

f In the early part of 1838, during the disturbances on the Niagara frontier, a mu- 
tinous, drunken soldier attacked a sentinel on duty at Buffalo, N. Y., who, in self de- 
fence, gave a thrust with the bayonet, which entered between the seventh and eighth 
left ribs, wounding the lung, from which there was tremendous hemorrhage. Being 
absent at the particular time, Surgeon H. L. Heiskell, Medical Director, saw the 
wounded man for me, and bled him copiously. He was again bled so soon as reaction 
and hemorrhage came on. These decisive bleedings, doubtless, saved the man's 
life. An attempt was made to keep the wound closed, but, after a day or two, this 
was found impracticable, by reason of difficult respiration, and the restless state of 
the patient, blood having accumulated in so great quantity as to fill the left side of 
the thorax and encroach on the right lung. Emphysema had also extended over 
the whole side, to the neck and face, contributing to the restlessness and difficulty 
of respiration. The wound was, therefore, reopened, and the patient laid on the 
wounded side. The effused blood gradually flowed out of the wound ; nor were inci- 
sions necessary to remove the emphysema, the air in the cellular membrane being 
gradually removed by the natural process. A profuse discharge of sanious and fetid 
matter followed, diarrhoea and hectic finally supervened, and the patient at one period 

No. XLIX.— Jan. 1853. 3 



30 



Porter, Surgical Notes of the Mexican War. 



[Jan. 



The Mexican lancers had been looked upon as a formidable arm of the 
enemy, but they were, in truth, the worst troops of their service. But few 
lance wounds, therefore, came under my notice. 

Lieutenant , Hays's Texan Rangers, received two lance wounds at 

Monterey, on the morning of the 21st of September, 1846. The right gas- 
trocnemius muscle was transfixed. The neck was also transfixed, from left to 
right, by a lance which barely missed the cervical vertebrae. These wounds 
were a long time in getting well, and required a good deal of attention, high 
inflammation supervening. 

Private Fielding Alston, Hays's Texan Hangers, received a lance wound 
through the right arm, on the morning of the 21st of September, 1846, at 
Monterey. High inflammation came on, and it was a considerable time before 
the patient was fit for duty. In both cases, cold applications were freely em- 
ployed at first, and poultices subsequently. 

Sabre wounds were as uncommon as bayonet wounds. Case V., in my 
first paper, improperly placed among gunshot wounds, was one of the best in- 
stances of sabre wounds which came under my notice. These wounds occurred 
mostly in the guerilla warfare, in the vicinity of Yera Cruz, in 1847. 

Antiphlogistic Treatment of Gunshot Wounds. — The free employment of 
venesection, as advised by Hennen and others, was seldom necessary in Mexi- 
co. To a certain extent, it might have been required in wounds of import- 
ant organs, but caution was necessary. The English soldier is much better 
off, as regards diet, exercise, pure air, peace of mind, and all the comforts 
of life, than the English labourer (Hennen, Mil. Surgery , p. 68), while the 
daily fare of the American labourer is abundant, and he is sure of earning a 
decent support for himself and family. Hence, the change of the citizen 
to the soldier, in the English service, is an elevating process, tending to im- 
prove the general system;, while, in the American service, the change is, for 
a time, depressing, particularly in the volunteer service, in which there is 
change of diet, climate, habits, everything ; add to all these, fevers, dysentery, 
&c, and it will be seen that caution was required in relation to profuse vene- 
section. A body of English labourers, marched suddenly to the field to en- 
counter the vicissitudes of an active campaign, would scarcely bear the lancet 
so freely, in general, as advised by most British military surgeons. M. Vidal 
strongly recommends the application of leeches around gunshot wounds ; but 
it is to be recollected that, in military 'practice, when leeches are most wanted 
it is impossible to procure them. Cathartics, laxatives, and antimonials are of 
the greatest benefit. " Few subjects," says Hennen, "bear full and free purg- 

was so low as to be considered moribund. He was treated, in the later stages, by 
nourishing diet, anodynes, port- wine, brandy, &c, and finally recovered. Dr. Heiskell 
and myself attended him anxiously, as much, perhaps, in relation to the legal bearings 
of the case on the sentinel (a much better man than the wounded one) as a regard for 
our patient. The case may be considered, on the whole, as an example of remarkable 
recovery. 



1853.] Porter, Surgical Notes of the Mexican War. 31 



ing better than soldiers;" and I suspect that few military surgeons can be found 
who will be disposed to contradict his opinion. Attention to the secretions is 
essential; and antimony, with acetate of ammonise, which act on the liver 
and skin, often supersedes the necessity of general bleeding. Occasionally 
blue-pill, followed by some of the neutral salts, &c, are of great importance. 
A full dose of opium, or one of the salts of morphia, at night, with antimony, 
and sometimes a few grains of calomel, followed by a laxative next morning, 
is frequently of the greatest benefit; always using opiates cautiously in 
wounds of the cranium. 

Diet. — The diet of the soldier is at all times a most important considera- 
tion. La soupe fait le soldat, may be regarded as a military axiom ; and 
herein consists the difference between the old soldier and the new levy ; 
the difference between the officer of experience and the one who has just 
mounted his epaulettes.* The diet of the rank and file on duty being so im- 
portant, that of the sick soldier is still more so ; arid the cookery of the sick 
man's little comforts forms one of the most difficult of the surgeon's duties in 
a large hospital, for I have never seen the oldest hospital steward, or cook, 
who knew how to prepare the most common article of diet for an invalid — as 
arrowroot, chicken-broth, beef- tea, &c, without instruction. 

The diet of the wounded in Mexico was more nourishing than that usually 
recommended by systematic writers. At Monterey and Vera Cruz, they were 
subjected to various debilitating agents; and, as soon as the first inflammatory 
symptoms had subsided, and there was the least appetite, the patients were 
put upon nourishing diet — as chicken-tea and broth, beef-tea and broth, beef- 
soup, coffee, fresh meat, &c. &c, and, in certain cases, an allowance of wine 
or even brandy. 

M. Vidal says : " Perhaps, in France, we are somewhat too severe in the re- 
striction of nutritious food, and keep our patients too long on a low diet. My 
own experience confirms the truth of the observation that purulent absorption 
goes on more readily in persons who are not sufficiently nourished during the 
healing of their wounds. * * The English surgeons, who follow this plan 
after amputation, obtain perhaps more success than we can boast of in France." 

M. Sedillot states: "In the last expedition to Constantine (in Algeria), I 
cured a great number of the wounded, in whom immense purulent collections 
had formed in the lower limbs, by prescribing freely brandy, coffee, fresh 
meat, &c, and by the use of warm dry applications. * * Many a case of 
purulent infection may be prevented by the timely administration of an emetic 
and the use of a nutritious and even a moderately stimulating diet." 

M. Malgaigne " Considers his results satisfactory, and owing to the treat- 
ment. He avoids, as much as possible, all scarifications and incisions, employs 

* I well remember what an intelligent volunteer soldier told me in the general hos- 
pital at Vera Cruz, in 1847: That nothing was more discouraging than to encamp by 
the side of a regular regiment, in which the diet was good, police good, and every- 
thing orderly and comfortable, and contrast its condition with the misery and destitu- 
tion in his own regiment. I told him that the officers ought to teach the men how to 
perform their duties. "How can our officers, sir, teach us our duties, when they 
don't know their own ?" was the response. Similar complaints were not uncommon 
among the volunteer soldiers. 



32 Porter, Surgical Notes of the Mexican War. [Jan. 



only the simplest dressings, and gives food to the patients as soon as any ap- 
petite is present. With regard to venesection, he scarcely ever employs it ; 
being a pupil of Broussais, he formerly recommended the practice, but has 
been deterred from its use by the fatal effects which he has witnessed. M. 
Malgaigne gives a document which has never been before published, the statis- 
tical account of the mortality amongst the wounded admitted into the hospitals 
of Paris in 1814. In these tables, French, Prussian, Austrian, and Russian 
subjects had been entered, together with a statement of the mode of treatment. 
All, except the Russians, were submitted to a severe regimen. The mortality 
was, French soldiers, 1 out of 7 ; Prussian, 1 in 9 ; Austrian, 1 in 11 ; Russian, 
1 in 27." — Am. Journal, October, 1848. 

This difference of mortality might have been owing somewhat to circum- 
stances, for the French may have been dispirited by defeat, and the Russians 
may bear wounds, hardships, and privations better than the other races, 
though scarcely to the extent shown in the tables. The starvation principle 
may well be abandoned in fevers and grave injuries, after the very first stage 
has passed, the reason being so obvious that an attempt at explanation seems 
wholly unnecessary. 

The successful treatment of wounds depends greatly upon the climate, and 
upon the season of the year, as observed by Baron Larrey in his campaigns 
in Egypt and Syria. Says the Baron : — 

"But if the wounds of our soldiers in Egypt and Syria, during the unfa- 
vourable season of Khamsyn (hot winds from the southern desert) were attended 
with many unexpected symptoms in consequence of the atmosphere at this 
season ; on the other hand, solutions of continuity were readily healed in Egypt 
during the prevalence of the north winds. The sky is at this time clear and 
serene ; the scorching and uniform heat is always tempered by the winds 
which begin to blow at sunrise, and continue while the sun remains above the 
horizon. * * * This combination of circumstances (the clear sky and north 
winds, good surgical dressings, and the healthy situation and condition of the 
hospitals) will serve to show why the wounds of amputated limbs healed before 
the thirtieth day ;* and why the operation for the stone was followed by a cure 
in fifteen days: why the operation of trepanning succeeded; and, finally, why 
large wounds, which penetrated the thorax and abdomen, with those of the 
extremities attended by a loss of substance, were cured so soon, and without 
ill consequences." 

Malte-Brun divides all Mexico into three regions with distinct climates, as 
follows : — 

" La contree du Mexique presente trois regions bien distinctes pour le climat. 
Les environs de la Vera Cruz, les 6tats maritimes de Cohahuila, du Texas, du 
Nouveau Leon, de Tamaulipas, d'Oaxaca, de Sonora-et-Cinaloa, les lisieres 
meridionales de ceux de Mexico, de la Puebla, de Mechoacan, et les cotes de la 
Californie, sont des terrains bas et entrecoupes de collines peu considerables. 
Leur elevation au-dessus de l'ocean ne depasse pas 300 metres ; leur tempera- 
ture moyenne est de 25 a 26 degr6s du thermometre centigrade, c 7 est-a-dire de 
8 a 9 degres plus grande que la chaleur moyenne de Naples. Ces regiones 
fertiles, que les indigenes nomment tierras calientes, c'est-a-dire terres chaudes, 
produisent en abondance du sucre, du coton, des bananes et de Findigo ; mais 
les vents du nord y soufflent depuis le mois cF Octobre jusqu'au mois de Mars, 
et souvent ils refroidissent Fair a tel point que le thermometre centigrade a 16 
degr6s." 

* Not by the first intention, it is presumed, for the Baron was a great enemy to the 
primary union of wounds after amputation. 



1853.] Porter, Surgical Notes of the Mexican War. 33 



In this region, less than 1,000 English feet above the level of the sea, are 
situated Matamoras, Tampico, Vera Cruz, and the whole coast on the Mexican 
Gulf. 

" Sur la pente de la Cordillere, a la hauteur de 1,200 a 1,500 metres, regne 
constamment la douce temperature du printemps: les fortes chaleurs et le froid 
excessif y sont egalement inconnus. C'est la region que les Mexicans appel- 
lent tierras templadas, ou terres tempere'es ; la chaleur moyenne y est de 20 a 21 
degres ; malheureusement cette hauteur est celle a laquelle les nuages se sou- 
tiennent au-dessus des plaines voisines de la mer, circonstance qui fait que ces 
regions temperees, situees a mi-cote, sont souvent enveloppees dans des brumes 
epaisses." 

In this region, 3,937 to 4,921 feet above the level of the sea, are situated 
the pleasant towns of Jalapa and Monterey. Saltillo is 319 feet above the 
extreme limit of the tierra templada. 

" La troisieme zone, designee par la denomination de tierras frias, ou terres 
froides, comprend las plateaux elev6s de plus de 2,200 metres au-dessus du 
niveau de Pocean." 

In this region, more than 7,218 feet above the level of the sea, are the 
city of Mexico, Fresnillo, and Zacatecas. Sante Fe, New Mexico, is 171 feet 
below this region or zone, this town being, according to Wislizenus, 7,047 
feet above the level of the sea. 

The wounded of our army at Palo Alto and Resaca de la Palma did better 
than the wounded of the other battle-fields in Mexico, for several reasons ; the 
army was in the low country near the sea, and under the influence of sea- 
breezes ; malaria* had not become developed ; the men were hale and hearty 
after the severe winter at Corpus Christi ; and the invalid and worthless por- 
tion of the troops had been left behind. 

At Monterey the reverse obtained ; it was late in the season ; there were 
hot days and cold nights; malaria was developed; the men were reduced by 
fatigue, exposure, and sickness ; and the army was at an elevation of more 
than 4,000 feet above the level of the sea; consequently, the wounded did 
not recover so well as at Palo Alto and Resaca. 

At Vera Cruz, and in the adjacent tierra caliente, in 1847, the wounded 
were exposed to a combination of those causes which seem to produce disease, 
and many of them died of yellow fever. Yet, even here, there were some 
extraordinary recoveries, as Evans and Williamson, cases in my first paper. 
A captain of the Louisiana battalion fought a duel with a brother captain, in 
the summer of 1847, and was shot through both thighs just posterior to each 
os femoris, which escaped injury. With duelling pistols at ten paces, it may 
well be conceived that the wounds were severe ; and, considering the season 
of the year, the climate, the previous dissipation of the patient, &c, they 
might well be looked upon as highly dangerous. I was not present on the 

* Malaria is used as a convenient term and nothing more ; no reference is made to 
its natm-e, here or elsewhere. 



34 



Porter, Surgical Notes of the Mexican War. 



[Jan. 



field of battle, but was called in consultation immediately after the fight. 
The patient entirely recovered. 

This case offered a good example of the effects of a bullet at the apertures 
of entrance and exit. The, patient was of immense size, with Herculean 
limbs ; and the orifices of exit were torn, ragged, and much larger than those 
of entrance. I have supposed this to be always the fact. M. Blandin, how- 
ever, maintains the contrary, and believes that the " error has been retained so 
long, from the experiments of Dupuytren and others having been made on 
inextensible materials instead of upon so elastic a body as the skin. M. 
Blandin had never met with a case in 1830 or 1848, in which the aperture 
made by the entrance of the ball was not larger than that of its exit. M. 
Malgaigne confirms M. Blandin's observations. When we find competent 
observers giving, with cases before their eyes, exactly contrary opinions, we 
are disposed to agree with M. Roux, that there is no absolute rule, much de- 
pending upon the force, distance, and direction of the impelling power. " For 
my own part, I have always believed that the aperture of entrance was smaller 
than that of exit, and I must still be permitted to continue of the same opin- 
ion, notwithstanding the reputation of MM. Blandin and Malgaigne; and I 
still believe that the elasticity of the common integument and muscles is the 
main reason why the orifice of exit is so much larger than that of entrance. 

In contrast with the foregoing case, Lieutenant R , 15th infantry, re- 
ceived a wound from a musket-shot in General Cadwalader's affair at the 
JPaente Nacional, about twenty miles from Yera Cruz, the bullet passing 
through the muscular portion of the thigh. All the wounded in this affair 
were sent to the Yera Cruz General Hospital as soon as practicable, and this 
particular wound never appeared badly ; but the patient gradually sunk, with- 
out febrile action, and died on the 4th of July, 1847. He had black vomit 
on that day, and was of a light lemon-yellow, dying of yellow fever, although 
he had no fever, in the common acceptation of the term. 

In the city of Mexico, elevated, according to Humboldt, 7,469 feet above 
the level of the sea, all the causes of disease which were in action at Monte- 
rey, operated in a still greater degree, and the wounded, it is well known, 
recovered badly. Great elevation may be a cause of disease, and may com- 
plicate the treatment, for every one knows the difficulty of respiration in a 
rarefied atmosphere several thousand feet above the level of the sea. " The 
great mountain plateau," says Humboldt, " which surrounds the volcano of 
Antisana, is 13,473 feet above the level of the sea. The pressure of the at- 
mosphere is so inconsiderable at this height, that blood will flow from the 
nostrils and mouth of the wild bull when hunted with dogs.* In the city of 

* The dogs must suffer in some degree, but not so much as the bull. Man and all 
living things have an organization adapted to their habits and -wants, and the perse- 
verance and fleetness of the dog in the chase, in all regions, depending upon his organ- 
ization, are well known. The condor, according to Humboldt, by means of membran- 



1853.] 



Porter, Surgical Notes of the Mexican War. 



35 



Mexico, elevated more than 7000 feet, the rarefication of the atmospheric air 
is so great that the difficulty of respiration and inability to sustain violent and 
long-continued exertion are well known, both in man and animals. Decar- 
bonization of the blood or hsematosis is not accomplished as in the low coun- 
try ; perspiration is wholly suppressed, or is so rapidly evaporated as to be 
insensible; and it is well remembered how rejoiced our officers were on re- 
turning from the city, while enjoying the luxury of a free perspiration in the 
tierra caliente in and around Vera Cruz. These causes of disease, variable 
temperature of the day and night in autumn, the development of malaria, the 
fatigue and exposure of the troops, imperfect hsematosis, and the suppression 
or rapid evaporation of the perspiration, appear sufficient to account for the 
mortality among our troops in the valley of Mexico, from wounds, fever, and 
dysentery. The check to perspiration, itself a cause of disease, may have 
greatly contributed to the difficulty of treatment, and to the mortality. One 
thing seems certain, that altitude near the equator is not equivalent, in the 
treatment of disease as well as in other phenomena, to high latitude. 

Abstract of the report of sick and wounded of the artillery battalion and 
Duncan's battery, for the quarter ending 30th September, 1846. 



Diseases. 

Fevers . . , ' . 

Diarrhoea . 

Dysentery, acute and chronic . 
All others of the digestive system 
Catarrh . 

All others of respiratory system 
Brain and nervous system 
Urinary and genital organs 
Rheumatism, acute and chronic 
Abscesses and ulcers 
Wounds and injuries 
All others .... 



Remaining at last report 
Aggregate 



July. 


August. 


September. 


Total 


15 


14 


36 


65 


14 


43 


41 


98 


19 


58 


29 


106 


6 




9 • 


23 


5 


16 


36 


57 





2 • ' 


1 


3 





1 





1 


1 


3 


1 


5 





4 


1 


5 


6 


20 


7 


33 


9 


29 


51 


89 


25 


48 


17 


90 


100 


246 


229 


575 








30 








605 



Sent to general hospital . . . ... . . 64 

Returned. to duty . . . . . . . r . . 508 

On furlough . . • . ., 1 

Died : > 2 

Remaining sick . . . . . . . < ' '" > 30 

605 

One died in the battalion hospital in July, and one in August, both of con- 
tinued fever. Two died in September, in division general hospital, in my charge, 
both of gunshot wounds. 



ous air-sacs, is able to soar to the altitude of more than 23,000 feet, a height at which 
the barometer scarcely stands at 12.7 inches, and he is also able to descend suddenly 
to the sea-shore ; thus, in a few hours, traversing, as it were, all climates. 



36 



Porter 7 Surgical Notes of the Mexican War. 



[Jan. 



MEAN STRENGTH. 



Month. 



Officers. 



Enlisted men. 



Total. 



July . 

August 
September . 



21 
27 

30 



255 
507 
586 



276 
534 
616 



Average 



475^ 



This brings us to the surrender and quiet possession of the city of Monte- 
rey, the establishing of the general hospital of the division in the Casa Arista, 
and the quartering of our division in the houses of the town. 

Monterey, the capital of the State of Nuevo Leon, containing about 12,000 
inhabitants, is situated in latitude 25° 40' 13" N. | longitude 100° 25' 36" 
W., on the left bank of the Rio San Juan, which disembogues into the Rio 
Grande a few miles below Camargo. The San Juan is formed by three main 
branches; the first or source, Arroyo* San Juan, arises in the vicinity of Sal- 
tillo and passes by Monterey on the south and south-east, sweeping partially 
around and encircling it; the second branch passes within two or three miles 
of Marin, twenty-five miles from Monterey ; and the third is near the little 
village of Ramos, about thirty-two miles from Monterey. Between Ramos 
and Marin, about thirty miles from Monterey on the north, is a mountain 
ridge of moderate height which looks towards Seralvo,f and bounds the basin 
or valley on that side ; on the south is the Sierra Madre itself, ten or fifteen 
miles from Monterey, rising several hundred feet above the waters of the San 
Juan, and covered two-thirds of the way to the summit with magnificent 
pines, the upper portion being destitute of vegetation. To the east of Mon- 
terey, about twenty miles distant, is an elevated spur of the Sierra Madre, the 
saddle mountain, Silla Camanche, from its resemblance to the Camanche 
saddle ; on the west and south-west are detached ridges and spurs of the 
Sierra Madre, among them the Mitre Mountain, so named from its resem- 
blance to a bishop's mitre. Within the basin formed by these mountain 
ridges are elevations of moderate height, as the Loma de Independencia, the 
Collado de la Federation, &c. ; and all these mountains and elevations belong- 
to the limestone formation. Near Monterey there are also, on the plains, 
extensive limestone quarries, from which most of the houses of the town are 
constructed, and the water of all the streams is strongly impregnated with 
lime. The valley, thirty-five or forty miles in its greatest diameter, is allu- 
vial, with the exception of the elevations and mountain ridges ; it is well 
watered by numerous streams, large and small ; and is fruitful, being covered 
by well-cultivated fields, and the gardens and lots of the town are filled with 
beautiful fig and orange groves. Both the town and valley are subject to 
autumnal intermittents and remittents, the inhabitants suffering from them 
in 1846 as well as our own troops. 

* Arroyo, a rivulet, a small river. 

f The orthography of this word is not settled ; in our official accounts it is Seralvo ; 
it is often Ceralvo. 



1853.] 



Porter, Surgical Notes of the Mexican War. 



37 



In quiet possession of Monterey, in quarters, with plenty of provisions, and 
the arduous duties of the campaign at an end, it might have been anticipated 
that our division especially, would enjoy an almost entire immunity from dis- 
ease. Not so ; the period of rest is the period of danger to armies, particu- 
larly in unhealthy countries : " The period of smallest loss to an army," says 
Mr. Alcoek, "is a victorious and vigorously prosecuted campaign." Could 
our army have marched to Saltillo and San Luis Potosi within a week after 
the capitulation, made daily marches, fought a battle or two, and suffered 
hardships and privations, it is verily believed that our cases of disease would 
have been a sixth less. This is in conformity to experience. In the terrible 
unhealthy summer of 1834, I attended a detachment of dragoons on an ex- 
pedition from Fort Gibson, west of the State of Arkansas, to the great west- 
ern prairies; and several days before our return to that post, we had not 
a man sick. In less than two weeks after encamping in the immediate 
vicinity of the fort, the whole detachment was so sick with severe remittent, 
that there were scarcely well men to take care of the sick. In the arduous 
summer campaign in Florida, 1841, when the Seminoles were pursued into 
their fastnesses and their corn cut up, the troops in the field were more 
healthy than those who remained at the majority of posts; convalescents 
from fever would volunteer to go on a " scout," preferring the casualties of 
Florida swamp service to the wear and tear of a monotonous existence at 
a worthless interior post, and they returned all the better for the service ; 
their health had improved. Baron Larrey states, Memoirs, vol. i. p. 406, 
that in the arduous campaign of 1805, previous to the battle of Austerlitz, 
during the whole march of the French army to Vienna, they were exposed 
to snow and rain, and the rapidity of their progress did not allow the soldiers 
time to dry their clothes. They were also deprived of such articles as were 
necessary to protect them against the vicissitudes of the weather, as the bag- 
gage had not been brought on, and rations could only be regularly distri- 
buted in the large cities : " Yet we had but few sick. Indeed, at our 
entrance into Vienna, our soldiers seemed to have become more robust." 

Sir Gr. Ballingall states : — 

" Disease goes hand in hand with indolence and inactivity, -whether of body 
or of mind ; and on the contrary, "when the minds of soldiers are agreeably 
occupied, and their bodies energetically employed, as in the attainment or pur- 
suit of victory, disease is kept in abeyance." 

Diseases of Monterey in the autumn 0/ 1846. — They were malarious, inter- 
mittents, and remittents, mostly the former in the battalion and in the divi- 
sion general hospital; but at other points, as the u Citadel," to the north, 
between the road to Marin and that to Monclova, there were remittents and 
congestive fevers, as I was informed by Assistant-Surgeon De Leon. During 
the operations around the town, and subsequent to the capitulation on the 
24th of September, the weather was variable, and the men were predisposed 
to these diseases from encamping in the low country in summer, exposure, 



38 



Porter, Surgical Notes of the Mexican War. 



[Jan. 



and fatigue. The following extract is from my Notes. — " September 25. The 
nights are quite cool; days not hot. 27th. Our sick are increasing in number; 
some of the wounded are doing well, others are not. October 1. The weather 
is clear and pleasant; the middle of the day rather warm; towards morning 
cold. 3d. Quite a cool morning ; warm in the middle of the day. Many of 
the men have severe wounds, but in general they are doing well. 6th. 
Cold morning; clouds hanging on the mountains; clear before the middle of 
the day. 7th. Flying clouds and strong easterly wind; hot in the middle of 
the day; cold at night. 8th. Strong east wind. 9th. Easterly wind; thick 
flying clouds, and rain about sundown. Warm night. 10th. Cloudy, with 
occasional sunshine; warm. A number of cases of intermittent to-day. 11th, 
12th, 13th, 14th, 15th. The weather pleasant. More or less fever cases daily. 
16th. The weather is bitter cold, and at the north the appearance of the clouds 
would denote snow. Fevers are extremely prevalent; very many are sick; 
and the effect on the wounded is unfavourable. 17th. Weather as yesterday, 
cold and unpleasant, and fever continues. 18th, 19th. Weather the same; and 
fever cases multiply as a matter of course. 20th. Cold, cloudy, and rainy. 
21st. Cloudy; warmer than for some days past; and fevers seem to be some- 
what abating. 22d. Cloudy ; and much warmer than heretofore. Not so 
much sickness; but there are cases enough to keep us all busy. 31st. Mus- 
ter day. Eather warm, but the weather is beautiful. From the 1st to the 
13th of the month, there were ten companies in all, nine of the battalion and 
Duncan's Battery ; and from the 13th to the end of the month, there were 
eight companies in all ; and the number of sick amounts to an average of 
14 to each company, or 21 per cent, of the battalion; and, including Duncan's 
Battery, to more than 24 per cent. The inhabitants of the town have suf- 
fered severely from fevers, as well as our own troops; from the hospital at the 
Casa Arista to the Plaza de la Capella, Campo Santo, or ( Cemetery,' a dis- 
tance of half a mile, whole families have been sick with intermittents and 
remittents." November 1. Fever cases admitted, 14; November 2, 39 cases 
of fever admitted ; and the disease continued, more or less, to the end of the 
year. 

Treatment of Fevers at Monterey. — So long as our quinine held out, there 
was no difficulty in managing the fevers, but this remedy had to be withdrawn, a 
limited quantity being essential to the severe cases. Pulv. cinchonas did very 
well as long as it lasted, but this gave out, and we then resorted to serpenta- 
ria Virginiana and other bitters. When these gave out, we took to sulphate 
of zinc and myrrh, sometimes with, and sometimes without opium, which 
answered a good purpose in the intermittents, though slower in its operation 
than the above-named remedies. I remembered what Dr. Eli Ives, the vete- 
ran professor of Yale College, had inculcated in his manuscript lectures in 
regard to the virtues of sulphate of zinc in intermittent fever : — 

"If there is any article which is a specific in intermittent fever, it is this. 
* * This is the remedy on which I most rely in intermittents of the ordi- 



1853.] 



Porter, Surgical Notes of the Mexican War. 



•7.' 



nary kind.* It very rarely offends the stomach : I give as many as four grains 
in pill at a dose without producing nausea. It excites the appetite, promotes 
digestion, and produces vigorous action of the system in general. Xo debility 
follows the use of the medicine, even when continued for months. A friend, 
who was going to establish a settlement on the lakes west of the State of Xew 
York, called on me for medicines and directions for treating intermittent fever. 
I directed him to evacuate the stomach with tartar emetic, and the bowels with 
calomel, and then give pills of sulphate of zinc, four a day. When he returned, 
he informed me that he did not fail to cure the disease in four or five days, and 
lie took with him a recipe of the pills, at the request, and for the benefit of those 
who had taken them." 

But the sulphate of zinc gave out, and I was obliged to resort, very unwil- 
lingly, to the use of arsenic, though not to the extent recommended by 31. 
Bourdin, "three centigrammes = 0.463 grs., or rather less than half a grain 
of the white oxyd of arsenic for a dose, generally daily I" Fowler's arsenical 
solution was mostly used. Fortunately, the opening of our communications 
with the depots at Camargo and Matamoros, and the arrival of a supply of 
quinine and other medicines and stores, rendered it unnecessary to continue 
the use of a dangerous remedy. Doubtless, arsenic is an efficient remedy in 
intermittent fever, but the effects, both on the stomach and system, will, it is 
hoped, prevent it from being frequently resorted to. Subsequent to its em- 
ployment at Monterey, many of the patients had anasarcous swellings of the 
limbs, face, and eyelids — oedema arsenical is — and general bad health. That 
a substitute for the sulphate of quinine should be found is of the utmost con- 
sequence, but the preparations of arsenic are the worst of all, and are appli- 
cable to special cases only. M. Andral considers that arsenic should be 
placed as next in value to quinine, and before all other remedies for ague. 
In answer to the question whether it should not be used instead of quinine, 
on account of the lowness of price, M. Andral says no. First, because it is 
apt to produce vomiting and other unpleasant effects in some cases; secondly, 
because it presents increased facilities for poisoning by rendering it possible 
to refer an effect to the medicine which was the result of another agency. 
On the contrary, arsenic should never be employed except where quinine has 
failed to do good. 

November 13, 1846. Our division marched to Saltillo, which was occupied 
on the . 16th. This town, the most important in Coahuila, is situated near 
the end of the mountain gorge, about fifty miles from Monterey, lat. 25° 26' 
22" X., Ion. 101° V 45" W., and contains 12,000 or 14,000 inhabitants. 
According to Wislizenus, Saltillo is 5,240 English feet above the level of the 
sea, or just above the tierra templada ; and its elevation above Monterey is 
variously estimated from 700 to 2,000 feet. It may be 1,000 feet above 
Monterey ; certain it is that the latter is the extreme limit of the orange, and 
the apple grows abundantly around Saltillo ; and after the capitulation quite 

*' In justice to Dr. Ives, it ought to be stated, that the above extracts were written 
several years ago, before sulphate of quinine was used so freely as at the present day. 



40 Porter, Surgical Notes of the Mexican War. [Jan. 

a brisk little trade in apples and oranges was carried on between the two 
towns. 

.Saltillo bears no comparison with Monterey in beauty or in the character of 
the inhabitants. On our march to occupy the town, a Mexican informed us 
that it was mucha mala, containing muchas putas y ladrones y matadores, 
and it was not long before our troops suffered from them. 

Venereal Diseases. — There was great difference during the war in their 
frequency in the different towns of Mexico. Matamoros, Camargo, Monterey, 
and Yera Cruz were quite free from them ; while at Saltillo and in the city 
of Mexico, on the contrary, they were rife, and of a virulent character. Our 
battalion did not suffer so severely at Saltillo as some of the infantry regi- 
ments, one of which in particular, when we left in January, was much crip- 
pled, requiring several wagons for those who were hors de combat. My 
limits will permit but a brief notice of these diseases. 

Syphilis at Saltillo was very common and very malignant. So much has 
been said on the subject in special treatises, that a few remarks in relation to 
treatment will be amply sufficient. Whatever was found upon the organs 
after a suspicious connection, whether pustule, excoriation, or inflammation — 
as M. Bicord says, "whatever its nature might be, and without an exact diag- 
nosis being requisite," it Was cauterized. In the treatment of indurated 
chancres, the lunar caustic was useless and injurious; creosote and nitric acid, 
employed early, were sufficient. So important was time considered, that the 
company officers were requested to induce their men to apply to the medical 
officers without delay the moment a suspicious appearance presented. By 
this means many suspicious appearances, or chancres, whichever they were, 
were quickly cured. When more advanced, indurated, and ulcerated, mercu- 
rials were considered necessary; and the preparations mostly used by myself 
were the proto-iodide, and the bichloride of mercury. The first is most fashion- 
able, and is certainly a valuable preparation ; but I must confess a partiality 
for the latter, from having employed it during many years in all climates and 
seasons, north and south, both in primary and secondary disease, with the best 
effects. In one of the latest editions of Ellis's Formulary is the following 
passage : " As salivation rapidly follows the use of corrosive sublimate, its 
effect must, be watched." The effect of all mercurials must be " watched," 
but the bichloride is far from producing ptyalism " rapidly;" and it induces 
ptyalism, according to my experience, less rapidly than any other preparation 
of mercury. Its effects are almost immediate, and in a day or two are mani- 
fested by indubitable signs, by the secretions generally, especially of the skin 
and kidney, but it does not readily bring on salivation. Wood and Bache 
say, U. S. Dispensatory: "It is less apt to salivate than most other mercu- 
rials. In minute doses suitably repeated, it may exert its peculiar influence 
without any obvious alteration of the vital functions, except, perhaps, a slight 
increase in the frequency of the pulse, and in the secretions from the skin 
and kidneys." As a general thing, too much mercury is given instead of too 



1853.] 



Porter, Surgical Notes of the Mexican War. 



41 



little. Druitt, Prin. and Prac. of Surgery, p. 206, says, that when there is 
" slight soreness and sponginess of the gums, with a slight increase of the 
saliva, it should be steadily maintained for four or five weeks, and until the 
sore has healed and all hardness of the cicatrix has vanished." Given in this 
manner, the remedy must surely be worse than the disease. The earlier edi- 
tions of Bicord and Acton give no very definite directions in regard to a 
mercurial course, but, according to the Brit, and For. Med.-Chir. Rev. for 
July, 1851, "when Mr. Acton lately visited M. Bicord at Paris, and asked 
him 1 How long must mercury be given after the disappearance of indura- 
tion V the reply was : * Six months, at least, may pass before leaving off the 
preparation/ which ought to be kept up to nearly the same dose which has 
effected the cure for that time ; and he added : ' Even then the patient must 
not be surprised at seeing the disease return.' Sir B. Brodie says, mercury 
should never be left off until the hard cicatrix disappears." This is rather 
severe practice; a patient must be mercurialized to death in the first stage of 
syphilis, for fear that secondary symptoms may appear; and when they do 
appear, the combined mercurial disease and syphilis must be treated together ! 
Abetter rule of practice from the above journal, is, perhaps, "to leave off 
mercury a very few days after cicatrization of the sore, convinced that a 
longer course is very uncertain as a preventive of further syphilitic affections, 
and more likely to injure the general health than the latent existence of the 
poison, even if it do exist, and that it in no degree assists us in the treatment 
of any of the secondary symptoms when they do arise." Indeed, it may be 
doubted if mercury is necessary in all cases " a very few days after cicatriza- 
tion of the sore too much mercury may be given by this rule. 

Sloughing Chancres. — These were not uncommon. In December, 1846, 
I went to Monterey on duty for a few days ; on returning to Saltillo, my 
assistant was urgent for us to visit a young lieutenant of artillery who had a 
sloughing chancre which threatened the immediate loss of the organ. Argent, 
nit. had been first used, and subsequently acid. nit. dilut. ; we determined to 
make an immediate and decided application of the pure acid ; but if the slough- 
ing continued, after twelve or eighteen hours, the actual cautery was to be 
employed without hesitation. But the pure acid was sufficient, and the 
patient recovered in a reasonable time, using tonics and good diet. 

Gonorrhoea was more virulent at Saltillo than I have ever seen it, often 
requiring the lancet and poultices to subdue intense inflammation, and also 
the free use of opium, camphor, tart, antim., anodyne enemata, &c. Injec- 
tions were never used in the early stage, for the inflammation was too intense; 
indeed, I am opposed to them in almost all cases. When the inflammation 
was in a measure subdued, the powder of cubebs was freely administered, 
being decidedly preferable to copaiba, though a combination of the two is 
sometimes necessary in obstinate cases ; but the balsam is more irritating to 
the kidneys and bladder than the cubebs, and has, moreover, so pernicious an 
influence upon the digestive organs that it is no favourite in my practice. 



42 



Porter, Surgical Notes of the Mexican War. 



[Jan. 



The powder of cubebs is a warm aromatic, and is much more grateful to the 
stomach than copaiba. Phimosis was sometimes so severe that a few cases, 
complicated with syphilis, required an operation. 

During our marches in 1846, our men were subject to spasmodic vesical 
ischuria, caused by sleeping on the ground. As the warm bath could not be 
employed on an active campaign, decided doses of tinct. opii and spts. eth. 
nitros. were administered, which rendered the introduction of the catheter easy, 
in the event of that instrument becoming necessary. Camphor and opium 
were also beneficial, and also tinct. opii camph. 

Abstract of the report of sick and wounded of the artillery battalion, Dun- 
can's battery, and a squadron of dragoons, for the quarter ending the 31st of 
December, 1846, 



October. November. December. Total. 



Fevers . . . . . 
Diarrhoea . 
Dysentery, acute . 
All others of the digestive system 
Catarrh .... 
All others of the respiratory system 
Brain and nervous system 
Urinary and genital organs . 
Rheumatism, acute and chronic 
Abscesses and ulcers 
Wounds and injuries 
All others .... 

Total taken sick . 

Remaining at last report 

Aggregate 

Sent to general hospital . 
Returned to duty . K 
Died . ■ . 
Remaining sick 



Died, in addition, two of the battalion in the general hospital of the division, 
in my charge, of gunshot wounds. A squadron of dragoons, about 150 men, 
included in the mean strength from November 21 to the end of the month ; 
cases 47 ; death, 1, of continued fever; entered on the 20th November, mori- 
bund ; died on the 21st. 









Aon 


25 


18 


12 


55 


25 


9 


3 


37 


1 




4 


8 


17 


18 


16 


51 





2 


3 


5 





1 





1 


2 





17 


19 


1 


1 


1 


3 


3 


• 9 


2 


14 


7 


17 


8 


32 


7\ 


13 


10 


30 


294 


349 


212 


855 








30 








885 








80 








718 








5 








82 








885 



MEAN STRENGTH. 



Montb. 

October 

November 

December 



Aggregate . 
Average 

This brings us to the end of the year 1846. 



Officers. 


Men. 


Total. 


29 


504 


533 


32 


617 


649 


26 


4-85 


511 


87 


1606 


1693 


29 


535 


564 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 



43 



Art. III. — The Practical Application of the Microscope to the Diagnosis of 
Cancer. By Francis Donaldson, M. D., Baltimore, Maryland. With 
three Plates, representing Cancer and other Histological Elements. 

There is, perhaps, no disease, not even excepting tubercular phthisis, which 
has carried off its victims to the grave with more unerring certainty than cancer. 
For centuries, it has been the dread of the human race. Every child understands 
that it is some loathsome disease, to be heir to which he would deem the 
greatest of misfortunes. Its distinctive character has rendered its very name 
significant of malignancy ; the ancient leprosy could scarcely have been 
regarded with more terror. Its known fatality has made it the study of 
pathologists of all ages, both as regards its nature and its treatment. Sad is 
the reflection that, even at this advanced stage of medical science, the in- 
ability to cure this disease is still one of those opprobria from which the 
science cannot rid itself. The physician is still often obliged to look on as a 
bystander, unable to arrest the malady, literally eating into the very vitals of 
his patient. We need surely, then, make no apology for adding, if it be 
merely our mite, to the investigation of this malignant disease. 

We have used the microscope in our researches, not merely to satisfy our 
curiosity, or because the study was interesting in itself, but that we might 
be able to deduce therefrom its practical application to the diagnosis, and thus, 
indirectly, to the treatment also. For although, as Dr. Bartlett* remarks, 
our therapeutics are not deducible from cur pathology • yet, it is true, as he 
proceeds to show, that diagnosis must be in advance of therapeutics. 

Some men are disposed to speak of investigations into minute, normal, or 
pathological anatomy, as if they had no bearing upon the practice of physic ; 
and would draw invidious lines of distinction between the science and the art 
of medicine, as if a knowledge of the two was incompatible. They forget, 
or intentionally overlook the fact, that the appropriateness of our treatment 
must be in proportion to the accuracy of our diagnosis, which, of course, is 
greater or less, according to the knowledge possessed of pathology. It is true 
that, after all, the actions of medicines cannot be arrived at from d priori 
reasoning, but by actual experiment, yet pathology must first give the data 
upon which to found our experimentation. 

In answer to the sneer of those who ask whether or not the treatment of 
disease is more successful, nowadays, based upon scientific principles than it 
formerly was — whether or not more lives are saved, we do not hesitate to 
reply, with Dr. Simon, in his recent work on Pathology, f in the affirmative. 
The negative results alone have, beyond a doubt, saved many a life. Who 

* Essay on the Philosophy of Medical Science, by Elisha Bartlett, M. D. 1844. 
f Lectures on General Pathology, London, 1851, and Philadelphia, 1852. 



44 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

can question that the old system of excessive drugging and exhausting blood- 
lettings, has hurried many a victim to his grave ? In this way, alone, the 
progress recently made in pathology has done incalculable good. Take, for 
example, Ricord's now well-demonstrated non-identity of syphilis and gonor- 
rhcea. What a bearing it has had upon treatment in preventing the exces- 
sive use of mercury ! The importance of a knowledge of pathological anatomy 
and of pathology can be called into question only by those who are ignorant 
of the true aim of their profession. 

It were well to bear in mind that no fact in science is worthless; if we do 
not now see its practical bearing, it will, sooner or later, be brought forth. 
M. Chevreul spent a quarter of a century in the study of fatty bodies, one 
result of which, alone — the use of stearine in the manufacture of candles — was 
worth all his labour. 

A few words to those who object to the employment of the microscope in 
the investigation of disease. It has been invariably the case that, when any 
additional mode of exploring disease has been invented, or any discovery 
made in medical science, many men, who, from their high position, it 
would have been supposed would cheerfully have supported it, have ob- 
jected until they were forced to admit it, although, perhaps, they could 
not avail themselves of it. Harvey, Jenner, and Laennec had to encounter 
the opposition of those upon whose aid they might have counted. Even to 
this day, when, if there is a department of medicine which is well established, 
it is auscultation, there are those found who cavil at it and question its ac- 
curacy, although they might as well deny any of the plainest phenomena of 
natural philosophy. The microscope has, unfortunately, been considered to 
be a mysterious instrument only to be managed, or even understood, by men 
of imaginative minds, who could fancy they saw in the field of the instrument 
any and all conceivable shapes. We are thankful that that erroneous impres- 
sion is fast fading away, although, in the United States, the practical use of the 
instrument is not generally understood in its application to medical science. 
Indeed, the manufacturers have been to blame in no slight degree for this, 
owing to their unnecessary complication of the machinery. The great number 
of useless screws and addenda have frightened the profession, and made them 
believe that, to understand its use, it was necessary to make it one's only 
study. Then, again, their arbitrary mode of estimating their magnifying 
powers by the camera lucida, has caused them greatly to exaggerate the 
power of their lenses. Microscopy, as it is improperly called, some have 
tried to erect into a new and separate science, when, in fact, it is merely a 
modification of our ordinary modes of observing — the manner of observing is 
the only new thing about it. In the examination of those bodies which can 
be seen well from their size by the natural eye, we do not call in its aid; for 
those, on the contrary, which are too small to be thus examined, we employ 
a physical machine, which, by the concentration, &c, of the rays of light 
proceeding from the object, bring it within the focus of vision. It is nothing 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 45 

more nor less than an improvement upon our sense of sight. "In this, as in 
all other improvements in medicine," remarks M. Ch. Robin,* " the first 
mode of objecting, is to deny the truth of the results; this, overcome by proof, 
they say that, after all, it is unnecessary, for the existing modes of investiga- 
tion are sufficient." 

But why is there such unwillingness to admit the progress of science ? Is 
it not because the facts revealed, overturn, or more or less modify existing 
theories, upon which are based all their practical deductions ? Was not such 
the case in the time of the discovery of the circulation of the blood ? 

If those who think there is no reliance to be placed on appearances in the 
field of the microscope would take any crystal, such as that of the beautiful 
octohedra of the oxalate of lime visible already to the naked eye, and mag- 
nify it by degrees, they would see that, no matter what the power of the 
glass used, it possessed the same number of sides, angles, &c. ; the only dif- 
ference being that the minute details, not visible before, would be brought 
out. They ought to remember that no matter how high the magnifying 
power of a lens, it cannot render visible things which do not really exist — it 
cannot create. The only question to be settled is, whether or not a cell or 
corpuscle of a certain form and size is constantly seen in such and such a nor- 
mal tissue or morbid growth, and not whether its appearance is the work of 
the imagination or of some mysterious creating power in the instrument itself. 
The constancy of the occurrence of the cell, &c, is what gives us a right to 
classify it as an element. We have heard the objection urged that in a few 
years all we now consider as established will be overturned; new investiga- 
tions, say they, will do away with existing views ; as manufacturers improve 
in their lenses higher powers will reveal new points. A strange objection this, 
which would stop all progress in science ! Are we to investigate nothing in 
science because our descendants may improve on our knowledge ? But is it 
correct? Are there no points settled in microscopy? Do higher powers 
destroy what the lower have shown ? Has the highest magnifying lens dis- 
proved the constant presence of peculiar corpuscles in the blood ? Is there 
anything clearer than the appearance of the morbid product known as pus ? 
Could there be a greater triumph for the truthfulness of the microscope than 
the now universally admitted fact of spermatozoa in the male semen? — not 
many years back, and the idea was ridiculed ! Have improved glasses done 
away with M. Donne's researches* in regard to them and to the colostrum 
corpuscle ? Is not the presence of pavement epithelial scales in some parts of 
the body, and the existence of cylindrical and ciliated ones in others, 
universally acknowledged ? Would not men doubt, if they could, the beautiful 
phenomena of ciliary motion, such as can be easily exhibited in the oyster, 
&c, or as can be shown on certain surfaces of the body ? We cannot forbear 

* Du Microscope et des Injections, Paris, 1849. 
f See Cours de Microscopic Paris, 1844. 

No. XLIX.— Jan. 1853. 4 



46 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

mentioning some other points in histology as established by the use of the 
microscope, such as the muscular fibres of animal and of organic life, the 
elements of white fibrous tissue, yellow elastic, &c, the fungous vegetable 
growths in true porrigo favosus, or in herpes tonsurans.* "It is true, the 
interpretation of these histological elements," observes M. Broca,"j" "is much 
discussed." Some think the spermatozoa are animalcules ; others, again (the 
now prevalent, and we believe, the correct view), hold that the motion exhibited 
is merely ciliary. The exact relation between the Haversian canals of bones 
and the canaliculi may be disputed, as may the question whether or not 
white blood-corpuscles are changed from lymph. But the form of these ele- 
ments and their invariable appropriate presence is not questioned. It is not 
true, then, that a stronger lens destroys what a feebler has revealed ; it must 
show the same element, only more in detail. 

The difference of opinion among microscopic observers, with regard to cer- 
tain points is no argument against the use of the instrument, any more than the 
differences among anatomists in regard to coarser anatomy is to be urged against 
the employment of dissections. The microscope ought no more to be con- 
demned for the errors of the microscopist than the scalpel for those of the 
anatomist, or chemistry for discrepant analyses. The use of the microscope 
has already shown the falsity of more than one theory, and abolished more 
than one hypothesis. "As at the epoch of Morgagni," says M. Broca, 
"pathological anatomy, though in its infancy, came in contact with the 
prevailing humoral theory and the empirical doctrines. It was not to be 
wondered at, that there should have been then, as there ever will be, a vio- 
lent contest between routine and tradition on the one side, and the progress 
of science on the other. But here, as in the time of Harvey, when the same 
contest was carried on with no little ardour, the innovations of science must 
finally prevail, although at each step it must fight its way." 

Our space will not allow of our giving more of the points in histology and 
in pathology elucidated by the microscope. We can do no more than allude 
to the settling the disputed nature of the dartos, showing it composed of a 
peculiar structure of its own; to M. Gosselin's demonstration,;]; that there is 
properly speaking no medullary membrane, and the confirmation of it by 
M. Robin ;§ to the turning of Bouillaud's views in regard to arteritis, by 
proving that neither the internal coat, nor, indeed, any coat but the 
adventitious or outermost of the arteries is vascular, consequently that 
there can be no such disease as arteritis, so that , the coloration taken as 
inflammatory is merely from imbibition. In the same way, calcareous depo- 
sits in the arteries, &c, were erroneously considered osseous in their nature. 

* See Des Vegetaux qui croissent sur l'Jiomme, &c. Par Ch. Robin. Paris, 1847. 
j- Quelques Propositions sur les Tumeurs dites Cancereuses, These. Paris, 1849. 
J Archives de Medecine. 1847. 
I Memoires de la Societe de Biologic 1849. 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 47 

We need scarcely speak of what the microscope has already accomplished in 
renal and urinary diseases. In that branch of medicine, a physician who is 
not familiar with the use of the microscope is cut off in his diagnosis from an 
invaluable aid, as necessary, in fact, for the proper understanding of it, as 
a knowledge of auscultation is for diseases of the heart and lungs. We need 
but refer the reader to the manuals of Golding Bird, Griffith, and Frick. 

The value of the microscope in forensic medicine should be acknowledged by 
all, even if its only service had been in detecting spermatozoa and blood-discs, 
the latter of which, according to Hassall,* can be distinguished in stains six 
months old. 

Thus we see that the microscope has already done good service to the pro- 
fession, and we may look forward to the not distant day, when its employ- 
ment, as a means of diagnosis, will be general.')' 

Certain it is, that we need every possible aid we can get in the difficult 
work of diagnosis; for how often do we see the most skilful acknow- 
ledging themselves baffled. If it was only in very rare cases that the 
microscope could furnish us with some insight into disease, it would repay 
the practical physician for the time and labour consumed in pursuing the 
study. But the fact is, that in numerous cases in every-day practice, its 
application in medicine renders clear obscure points in disease. It was truly 
said by Andral, that to it and to animal chemistry must we now look for pro- 
gress in medical science. 

The following deductions in regard to cancer have been arrived at from 
many observations collected during the past three years ; eighteen months of 
which time were passed in Paris, where the material offered for examination 
was very great. For many of the specimens we are indebted to our friends. 

Of course, we have availed ourselves of the results of others ; indeed, we 
have examined all that has been written on the subject within our reach. 
The existing knowledge of no disease shows so well the gradual progress that 
has been made in medical science. It may not be uninstructive to trace 
briefly the doctrines held at different periods as to the nature of this disease. 
The term cancer was applied by the Romans to the morbid condition termed 
gangrene by the Greeks, and carcinoma had the signification now generally 
attached to cancer, being first used to designate certain ulcerations of the 
mammary gland. The name cancer was supposed to have been given on 
account of a fanciful resemblance to the body and claws of the crab, remarked 
in the tumour with its surrounding veins dilated from the obstruction to the 
return circulation. It may have been, as others conjecture, that the ancients 
thought there actually existed in the parts affected an animal which devoured 
the tissues. However, the name, whether originally so intended or not, is 

* Microscopic Anatomy of the Human Body. London, 1849. 

-j- It is with peculiar pleasure we welcome Dr. Bennett's new work Clinical Lectures, 
in which the practical use of the microscope is shown in daily practice — a new era in 
medical literature and hospital instruction. 



48 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

symbolical of the loathsome and destructive character of the disease. As far 
back as Hippocrates, who considered black bile as its cause, cancer was divided 
into the ulcerated and non-ulcerated; the former taking the name of cancer 
proper, and the latter that of scirrhus. After that, the term soft cancer was 
applied to the morbid product now known as encephaloid. This has been 
resisted by Abernethy and others, but earnestly contended for by Bayle, who 
included with them all intractable cutaneous ulcerations. 

Ambrose Pare, the father of French surgery, gave his division of cancer, 
which he thought had its origin in the different kinds of melancholy. 

In looking over the catalogue of the various doctrines taught at different 
periods in regard to this disease, we have been forcibly struck by the indefinite 
and confused views held on many questions which have been so much eluci- 
dated by Corvisart, Laennec, and Bayle in their pathological investigations. 
Laennec described the physical characters of cancer, and went profoundly into 
its origin and tendency. His successors, MM. Andral, Cruveilhier, and Vel- 
peau followed in the same train. In England, we owe much to Sir Astley 
Cooper, for his division of mammary tumours into benign and malignant or 
cancerous. According to Dr. Walshe,* Dr. Young ought to have the credit 
of having first classified scirrhus and encephaloid as species of the genus 
cancer or carcinoma. Dr. Walshe claims for himself, what in justice should 
belong to Laennec, the having placed colloid in juxtaposition with scirrhus 
and encephaloid as another species. 

At this stage of the history of this disease, we cannot refrain from calling 
attention to the confusion which still reigns in the doctrines taught, which 
are those held by the majority of modern surgeons, and generally lectured 
upon in our medical schools. They divide cancer, as did Laennec, into three 
varieties; but what points do even such authorities as Berard,f Samuel Cooper,£ 
or Dr. Warren give us, by which we can distinguish the class of morbid growths, 
to which they give the indefinite name of malignant, without stating in which 
of the various senses they apply the expression ? It is true that close observers 
noticed that certain exterior characters generally accompanied those tumours 
which proved fatal. How are we to judge of a tumour in the mammary 
gland, whether or not it be fibrous, scirrhus, or simple hypertrophy of the 
proper tissue of the organ itself, either during life or after death ? What 
rules are laid down, even by the most observant and the most skilful, to dis- 
tinguish what they designate malignant growths from what they call simple 
sarcoma? And again, what definite meaning is attached to this term? If it 
attacks the bone, it is called osteo-sarcoma ; then, again, we have mammary 
sarcoma, medullary sarcoma, &c, some of which are admitted to be as de- 
structive as cancer, from which many do not separate them. 

* The Nature and Treatment of Cancer. London, 1846. 
f Dictionnaire de Medecine, en xxx. vols., vol. xv. 
X Surgical Dictionary. 



1852.] Donaldson, Application of Microscope to Diagnosis of Cancer. 49 



The lancinating pain, so much relied upon by some, even Abernethy ac- 
knowledged could be caused by non-cancerous tumours. We used to be told 
that, if there was a grating sensation perceived on scraping the cut surface of 
a tumour, that it was cancerous in its nature; but who has not seen simple 
fibrous tumours, which have existed for years within the walls of the uterus, 
in which this sign was perfectly evident ? 

The term 'malignant must be acknowledged by all to be inappropriate to 
any one disease, whether applied to designate a sore, which, by ulceration, 
spreads and destroys life, or to a tumour which has the tendency to recur 
after extirpation, or as implying a constitutional taint. What more malignant 
in the sense of destroying life by ulceration, than phthisis ; by sloughing, than 
hospital gangrene; by softening, than ramollissement cerebri? What more 
destructive than constitutional syphilis ? Simple thickening of the pylorus, 
or any acute ulceration of stomach or intestine could, with perfect propriety, 
receive the name of malignant. "The only sense in which this favourite term 
can be applied/' justly observes 3Ir. Bennett,* " exclusively to cancer, is in 
regard to its returning again but, as we shall show, further on, it is true, 
even in that respect, only in a qualified sense. It would be well if we could, 
as Dr. Walshe proposed, relinquish altogether the term malignant, as appli- 
cable only to cancer ; indeed, it would be better still, if the name itself of 
cancer could be expunged, and some more significant word used. But it is 
next to impossible to eradicate a word so long in general use, and we must 
mend the matter by endeavouring to give it a definite and clear meaning. 

We do not wish to be understood to say that correct diagnoses cannot be some- 
times arrived at by surgeons who judge merely from the coarser physical cha- 
racters, so to speak, particularly when the disease is located in some exterior 
organ, and has progressed so far as to ulcerate deeply or to break down the 
strength of the patient. But we unhesitatingly say that often there is great 
confusion and doubt even among distinguished surgeons, at the most important 
period of the disease. We, ourselves, have known of several instances where 
the great Yelpeau, than whom no one has ranked higher as a surgical patho- 
logist, has extirpated as scirrhus of the breast what proved to be nothing more 
than simple hypertrophy of the proper tissue of the gland. We mean to 
express our conviction that there can be no just and satisfactory classification 
of morbid growths not founded upon their intimate microscopic structure ; 
that, if we rely, as heretofore, merely upon their superficial or coarser physi- 
cal characters, such as volume, consistence, colour, &C., we must often class 
together things which are, in fact, very dissimilar. This department of sur- 
gical pathology without the microscope is just where the diagnosis of diseases 
of the heart and lungs was, before the discovery of Laennec ; or, as obscure 
and unsatisfactory as the doctrines of essential fevers were before they were 
distinguished by their anatomical lesions, as when names were given to them 



* Cancerous and Cancroid Growths, by J. H. Bennett, Edinburgh, 1849. 



50 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

according to the grade of febrile reaction, and when, of course, they were often 
confounded with inflammations. 

" We should not be accused/' justly observes M. Broca, u of presumption 
in thus speaking of the errors of distinguished surgeons, our masters. Their 
ability, their genius, are not denied. We cannot but feel grateful to them, 
and reverence them. We impute the errors they committed, and the incom- 
pleteness of their doctrines, not to them, but to the insufficiency of their 
means of investigation. " The study of auscultation requires no particular 
talent, yet who can doubt but that any one, who is familiar with it, could 
diagnose with more accuracy many diseases than could a Sydenham ? 

The labours of Baillie, Hope, and Laennec, and, in our own times, Cru- 
veilhier, Rokitansky, Barth, Velpeau, and others, have obtained invaluable 
results from the older methods of research; they had, indeed, apparently 
made as much advance as could be made in this way. " But," remarks Dr. 
Lyons,* " the laws of morbid association and the statistics of diseases were 
yet to be deduced. The microscopist and the chemist have started a new era 
in pathology, and cleared much which was before obscure." 

The use of the microscope had been taken advantage of in many branches 
of natural science. Botany, Zoology, and Mineralogy have all been greatly 
elucidated by its employment. Such works as that of Ehrenberg's are sel- 
dom met with in any science. It was not to be supposed that the human 
body would remain unlooked into. As far back as 1722, Leuwenhoeck applied 
the microscope to find out the intimate structure of our different tissues; but 
it appears to have been a mere abortive effort, for the science remained nearly 
dormant for a whole century, when Edwards's, and afterwards Dutrochet's in- 
vestigations were published. It was not, however, until about the year 1835 
that medical science received any impulse in regard to microscopic researches 
into the minute constitution of cancer. Several prominent men on the con- 
tinent of Europe commenced their investigations about the same time, but it 
is principally to the distinguished physiologist, Mtiller,f that we are indebted 
for the first microscopic investigation of morbid growths. M. Schwann's 
theory of cell-formation gave a powerful impetus to these researches. Midler 
certainly accomplished much in his treatise, for he was the first to attempt to 
arrange and classify tumours according to their minute composition. He 
separated enchondromatous tumours, and what he called albuminous sarcoma 
from cancer. But his work was far from being complete; it was founded, 
not upon cases observed clinically by himself, but upon specimens handed to 
him. He did not find a constant element in cancer, because he considered as 
unquestionably cancer, what the surgeons had extirpated as such. He ob- 
served the tumours, but not the patients. Had he compared what he saw 
anatomically and microscopically with observations at the bedside, there would 

* An Apology for the Microscope, by R. D. Lyons, M. D., Dublin, 1851. 
f Muller on the Nature, &c, of Cancer, translated by West, London, 1840. 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 51 

have been more reliance to be placed upon his results. His great merit 
was in leading the way. It was reserved to M. Lebert, in publishing, 
in 1845, after unequalled industry and research, the results of his micro- 
scopic observations, to define clearly cancer by the microscope.* The 
first years^ of his manhood were devoted to zoology and botany, as Les 
Annates cles Sciences Naturelles bear good evidence in his many valuable 
contributions. A good preparation this for his medical studies. He had 
there learned to observe and to rely upon facts carefully ascertained. He was 
struck in commencing his medical studies with the absence of that mathema- 
tical precision he had always been accustomed to; he found the profession 
governed more by a science of tradition than by one of observation. He 
naturally, at once, became a disciple of Louis, whose name will ever be asso- 
ciated with the true starting-point in medical science, he being the first to 
insist upon the application of the Baconian principles of philosophy to the 
science of medicine. The adoption of these principles, in all departments of 
medicine, he saw, as all must, is the only sure way of arriving at anything 
like an approximation to truth. Based upon such principles, his works, like 
those of the founder of this era in medicine, must remain forever. His re- 
searches on Inflammation; his discovery of the Tubercular Corpuscle; his divi- 
sion of Tumours with the Fibro-Plastic Element; and his classification of 
Cancerous Growths ; his investigations on the Formation of Callus, must ever 
be valuable. His more recent works (monographs), on Scrofula,"}" Cancer,J 
and Hypertrophy of the Mammary Gland,§ are justly considered three of the 
most remarkable and complete treatises ever published. By him it was, that 
cancer was defined with precision and clearness, and we shall have frequent 
occasion to quote his authority. It was, in fact, to test, as far as we could, 
the accuracy of his statements that we have carried on our comparatively 
limited investigations. 

In his recent work,|| he says that years of clinical observation have con- 
firmed his deductions in regard to the cancer element. 

Dr. Walshe, in his treatise, has devoted but little space to the consideration 
of cancer elements. 

We may be asked why there is such diversity of opinion existing among such 
observers as Miiller, Walshe, Yogel, Bennett, and Lebert ? Why is it that Le- 
ber t has been able to draw out with so much more clearness than the others these 
particular elements ? Why so much confusion with others when he has no 
difficulty ? Our answer is to us very plain : the lenses he employs are finer 
and more powerful. We shall hereafter allude more particularly to the inter- 

* Physiologie Patliologique, Paris, 1845. 

f Traite Pratique des Maladies Scrofuleuses et Tuberculeuses^ par H. Lebert, 1849. 
% Traite Pratique des Maladies Cancereuses, &c., par H. Lebert, 1851. 
| Le rilypertrophie Partielle de la Grlande Mammaire, 1850. 
|| Traite Pratique des Maladies Cancereuses, &c. Paris, 1851. 



52 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

esting work by Mr. Bennett upon this subject. In regard to Vogel's plates,* 
we doubt if any one can get from them any clear idea of any cell or minute 
element, with the exception of things which require but a very feeble magnify- 
ing power to distinguish them, such as crystals of cholesterine, pus globules, 
and compound granular corpuscles. He gives as tubercular corpuscles what 
resemble more than anything else free epithelial nuclei, such as are found in the 
minute bronchii. His mistakes, and the confusion in which he has involved 
these matters, are all owing to the feeble lenses employed. According to his 
own estimate, he saw these corpuscles of tubercle with a power of 220 dia- 
meters, when it requires at least 450 diameters to see them at all. We, in 
examining tubercle, use a lens of Nachet's (No. 7),f of a magnifying power of 
833 diameters, according to the most accurate modes of measurement : with 
this we have no difficulty in describing the corpuscles peculiar to tubercle (see 
Plate III. Fig. 3), the most constant and unvarying of all. With a triple phos- 
phate crystal, or one of uric acid, which can be well seen with a feeble lens, 
it is unnecessary to employ higher powers ; but with many of the minute 
elements of the different tissues and products, it is necessary, in order to 
see them distinctly, to use our highest glasses. With a strong lens there is 
no danger of confounding pus globules with white blood-corpuscles, or of 
finding any peculiar globules in mucus. We often hear it said, that for all 
practical purposes a small microscope with a lens of two or three hundred 
diameters is all-sufficient. This is a mistake. A microscope, to be applied 
constantly by a physician, ought to have high as well as low powers, otherwise 
he can only partially observe. Moreover, these small instruments are without 
micrometers to measure the diameters of the objects, a very important ele- 
ment of diagnosis j not to mention the absence of a polarizing apparatus, 
&c. The absurdity of saying, as some do, that there is no confidence to be 
placed in the accuracy of the higher lenses, is as apparent as the assertion of 
others who believe nothing but what they can see with their naked, unaided 
vision. The rays of light passing through lenses placed one above another 
cannot show what does not exist ; if the glasses are achromatic, and have a clear 
definition, there can be no obscurity. We cannot but think that if Mr. Bennett 
had used a higher power than 250 diameters, his evidence in favour of the pecu- 
liarity of cancer elements would have been much stronger. It is, however, say- 
ing a great deal when he admits that the microscope is as useful to the surgeon 
in the diagnosis of cancer as the stethoscope is to the physician. It would be an 
exaggeration to say of any rational system, or of any physical sign, that it 
was a certain, infallible indication of a particular lesion. The observer would, 
indeed, be narrow-minded and contracted who would rely in forming his diag- 
nosis only upon one of the points attainable, as to the nature of the disease, 

* The Pathological Anatomy of the Human Body, by Julius Vogel. Translated by 
Dr. Day. American edition, 1847. 

f With Natchet's oblique prism, his short-eye pieces can be used with the high ob- 
jective glasses, giving a clear definition. 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 53 

instead of grouping them altogether, giving each its due weight. Does any 
auscultator rely upon physical signs exclusively, although there are certain of 
them, the indications of which, even by themselves, are almost pathognomonic? 
In answer to the question, whether or not we believe there is a peculiar inti- 
mate structure, under the microscope, of true cancer, by which it can be dis- 
tinguished from all other tissue, normal or pathological, we do not hesitate to 
reply in the affirmative — in the form of clear and well-defined elements. 

We do not pretend to say that there may not be shown, in the field of the 
instrument, a cell about which there could be doubt; nor that, under all 
circumstances, could a microscopic preparation be pronounced cancer or not. 
There could not always be such certainty of even anything which is as well 
marked as striated muscular fibre. But this does not lessen the reliability of 
our assertion that cancer has its constant element. We believe that, from 
careful microscopic examination of a piece of fresh tumour, for decomposi- 
tion or alcohol changes it very quickly, its cancerous or non-cancerous nature 
can be asserted with confidence. In fine, we hold that the employment of the 
microscope is more accurate in finding out the structure of cancer than auscul- 
tation in defining the exact lesions of the heart and lungs ! This we hope to 
be able to show to the mind of the reader as clearly as we ourselves are 
convinced of it, by dwelling particularly upon the points of differential diag- 
nosis. At best, auscultatory sounds alone are merely signs of the physical 
not of the pathological condition. During the past session, we have had seve- 
ral opportunities of exhibiting, to the satisfaction of a class of students, the 
marked difference between cancer and other elements. The few cells with 
which Mr. Bennett thinks cancer can be sometimes confounded we will com- 
pare side by side, in order that the reader may observe their marked dissimi- 
larity. 

We admit that we have examined morbid specimens extirpated as can- 
cer, which did not contain the characteristic appearance, but which were com- 
posed generally of either epithelial or fibro-plastic cells. These classes of 
tumours, Lebert appropriately calls cancroid, from their resemblance to true 
cancer. Mr. Bennett, M. Lebert complains, has extended too far the use of 
this term, by applying it to nearly all morbid growths, such as cartilaginous, 
fibrous, fatty cancroid tumours. Has Lebert proved* nothing in regard to 
the uncertain diagnosis of surgeons, as to the nature of tumours, by showing 
that Velpeau, Blandin, Malgaigne, and others of the highest reputation, have 
extirpated as schirrus of the mammary gland what in fact was nothing more 
than simple hypertrophy of the gland itself ? 

But, after all, it is objected by some that the microscope can be of no service 
in the living subject, for it is after death that you discover what caused it, or 
it is only after an operation you detect the nature of the disease. Even 
were this true, it would not destroy the propriety of its use as a means of 



* L'Hypertropliie Partielle de la Glande Mammaire, Paris, 1850. 



54 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 



diagnosis, for the discovery of post-mortem lesions assuredly throw light upon 
the symptoms manifesting and accompanying them during life. It would be 
considered absurd to say that the lesion of thickening and ulceration of 
Peyer's patches is of no assistance in the diagnosis of typhoid fever, because 
it can actually be seen only after death. The bearing upon the prognosis is not 
less apparent. But the fact is that, in the case before us. it is possible some- 
times to find out the exact nature of the disease before the knife has been used 
or death supervened. M. Lebert gives several instances where, by the use of 
his exploring needle, he was enabled during life to withdraw some of the 
elements of cancerous tumours, and thus diagnose them. vVithin the last 
year, we ourselves have been able to diagnose cancer on the living subject, in 
six instances, by nipping off little projecting points of the ulcerated sur- 
faces. In one case, at the request of Professor N. E. Smith, of a patient at 
the Baltimore Infirmary, when there was extensive disease, with induration 
and ulceration of a doubtful character, of the penis; in another, by the kind- 
ness of my friend, Dr. Van Bibber, in a patient of his, suffering with a 
tumour accompanied with deep-seated ulceration of the posterior fauces; in 
a third, a patient of Dr. Maris" s, there was a large encephaloid tumour of the 
neck ; in two cases of disease of the neck of the uterus ; and in another ulcer- 
ated penis. In all, the microscope revealed unmistakable evidences of cancer. 

There is no evading the plain fact that it is almost impossible to give 
even an approximate definition of cancer as it is generally understood ; for it 
is not a special disease, but a group of affections having in common certain 
physical characters. It was necessary, in order to give a clear signification to 
the word, to separate the various morbid growths classed together under the 
name of cancer. This 31. Lebert has been able to do by the aid of the micro- 
scope, into three distinct varieties, each having its peculiar characteristic 
histological element : — 

1. Cancerous tumours, properly so called, the only ones which should here- 
after be so designated, having the cancerous element without analogy in the 
economy. 

% Fibroplastic tumours, with its peculiar microscopic element, found in 
certain parts, also, of the healthy structure. 

3. Epithelial tumours, characterized by the epithelial element, the same as 
that found as a normal constituent of the epithelium and epidermis. 

To render his classification of the various morbid products clearer. M. 
Lebert draws the important distinction between those elements found nor- 
mally in the body, to which he gives the name of Tiomomorphous ; and those 
not so met with, but as invariably the product of disease or heteromorplious. 
Under this last head he places cancer, tubercle f pus, &c. ; under the former, 
fibres, muscular tissue, wliite fibrous tissue, fibroplastic, epithelial elements, ke. 
Homomorphous growths can be the product of disease as well as the others. 

Before speaking of the microscopic constitution or the dements of cancer, 
let us pass briefly in review the characters of the tissue of cancer which is 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer, 55 

ordinarily divided into three varieties, scirrhus, or hard, stone cancer j encepha- 
loid, or soft cancer; and colloid, or gum cancer. The first is firm and hard, 
owing to the amount of fibrous tissue; it is less vascular than the others. 
The encephaloid resembles the tissue of the brain, and is more or less firm 
according to whether it is at the commencement stage or further advanced. 
It is the most vascular kind, and becomes melanotic more readily than either 
of the others. "When it becomes exceedingly vascular, it receives the name 
of fungus heematodes. The third, the gelatinous form, has the cancer ele- 
ment mixed with the common uniting tissue ; the coloration varies accord- 
ing to the proportion of elements or tissue present. If the former predomi- 
nate, it has a yellowish tinge ; if the latter, the tumour has a transparent 
aspect. There is a species of tumour which is colloid, but not cancerous, con- 
taining fibro-plastic elements combined with cellular tissue. The cases of 
cancer where there is extravasation of blood, might be designated as another 
form. To a variety, where the tissue is of a pale, dull yellow, resembling 
tubercular structure, M. Lebert has given the name of pliymatdide. Some 
writers speak of soft cancer as a degeneration of the hard, but this manifestly 
is an error; it is, in fact, the more frequently met with even in the incipient 
deposit. Moreover, all these forms may be seen in the same specimen. 

It is improper to attempt to divide cancer into so many species, as they all 
have the same common pathology. The variety of aspect, consistence, volume, 
coloration, and vascularity, is caused merely by the amount of fibrous ele- 
ment, of fat, or of gelatinous fluid present ; all of which are purely accidental, 
and in no way essential to constitute the growth. The density, softness, &c, 
may also vary according to the organ involved ; the breast and the pylorus 
take generally the form of scirrhus ; whereas the bladder, the kidneys, &c, 
are more likely to be affected with encephaloid. Compare the physical cha- 
racters of cancer with those of the simple tissues, such as the muscular, areo- 
lar, dartoric, osseous, &c, or with those of the compound, as the glandular, 
the synovial, the mucous, &c, and the difference will be very apparent. Its 
greater or less firmness, its homogeneous fibrous aspect with its lactescent 
infiltrated juice are very characteristic. The presence of this peculiar fluid is 
of itself a point of differential diagnosis of great value ; the microscope always 
detecting in it, when found, the presence of cancer cells, &c. No matter 
what organ is the seat of the disease, this fluid can generally be scraped from 
the cut surface, or squeezed out by gentle pressure. It is particularly abund- 
ant in encephaloid, and frequently oozes out in drops having a white cloudy 
appearance of the consistence of cream, and very much of its colour, being 
slightly tinged with yellow. It may sometimes, on superficial inspection, be 
confounded with light-coloured pus, which has, however, with the yellow, a 
slightly greenish tinge. If, from the conditions of its formation, there can be 
any doubt, an appeal to the microscope will at once settle it by giving us the 
characteristic pus globule. (See Plate II. Figs. 5 and 6.) 

The cancer juice forms readily an emulsion with water, and in this differs 



56 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

from tubercular matter and from that pressed from sebaceous tumours. The 
colour of this juice, is of course modified by the mixture of other fluids with 
it; thus, when the vascularity is great, it is often reddish; when from a depo- 
sit of dark pigment, we have what is called melanotic cancer, it becomes of a 
dark brown. When mixed with much fat, it is more consistent; in colloid, 
it is thicker and sometimes grumous. 

We may be asked, what is cancer ? If it is meant what is the cause pro- 
ducing the disease so called, we are forced to acknowledge our ignorance; 
there is a point in regard to this and many other affections beyond which 
science has nofryet fathomed. We know that the disease is peculiar in its 
nature, in its progress, and in its results; but it is beyond the ken of man to 
divine what produces the predisposition to its development. To define can- 
cer as a tissue produced by disease is not so difficult. Its fundamental cha- 
racter is the substitution of a new tissue formed of heteromorphous elements 
for the normal structures formed of homomorphous elements, causing the 
latter to disappear as it progresses. In the first instance, owing to a peculiar, 
profound, and inaccessible predisposition, a lymphatic gland, the skin, the 
bones, or some other part or organ of the body becomes the seat of a local 
manifestation of disease by the deposit of certain elements foreign to the 
healthy state. As the malady advances other organs and tissues become 
involved ; and, finally, the whole economy becomes affected, and secondary 
deposits occur in parts far removed from the primary point of disease. 

So thoroughly is the whole system contaminated by the poison, that if the 
morbid growths be removed, the disease almost inevitably returns; and, 
finally, produces death. The extirpation was no cure, for the same constitu- 
tional cause which originated the mischief, continues to act, and, sooner or 
later, the reproduction of the evil either in the part first affected or elsewhere 
will show itself. We do not speak of the certain return of cancer without 
having the highest authority for our statement. The statistical results given 
by Dr. Walshe are very conclusive on this point. M. Lebert says, that out 
of 447 cases observed by him, in and out of hospitals, in which he recognized 
the microscopic element of cancer, not one case, which could be watched, 
escaped without a return after extirpation; rarely did even two years elapse 
before there was another deposit. M. Broca, who, while interne under Blan- 
din at Hotel Dieu, had the opportunity of observing a large number of cases, 
confirms Lebert's statement; in his own expressive words, "le veritable can- 
cer ne pardonne jamais/'* 

Sometimes, even when the local mischief is not of itself sufficient to cause 
death, its deleterious effects upon the constitution prove fatal ; in fact, occa- 
sionally after operations, the body succumbs from the effects of the poison 
before there is any manifest reproduction of the disease. This unerring 
fatality cannot fortunately be ascribed to any other of the accidental products 



* Quelques Propositions sur les Tumeurs dites Cancereuses. Paris, 1849. 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 57 

man is heir to. Cancroid epidermic, or rather epithelial growths, for they 
are found both externally and internally, can destroy life, and may return 
after extirpation ; but with them the mischief is local, being caused by an 
excessive production of a normal element ; and, consequently, their reappear- 
ance is local — at the point where the first existed, but never in parts far 
removed. Exactly as we sometimes see a return of a common lipomatous 
tumour in situ from all of the original not having been taken out. When 
death occurs from epithelial tumours, it is from extensive local, not constitu- 
tional mischief. They differ anatomically and microscopically from cancer in 
being in the first instance homomorphous without any deposit of cancerous 
matter. Epithelial tumours must originate from surfaces covered by epithelium 
— their growth is slower than that of true cancer. Many of the pretended 
cases of cutaneous cancer are epithelial, as were doubtless many of Lisfranc's 
uterine cancers, in which he met with such success. Local injuries sometimes 
produce them. The mouth, the lips, and the neck of the uterus are their 
favourite seats. 

Cancer is far more malignant than tubercle, which is also a heteromorphous 
substance, and which proves fatal, not so much from the poisonous effect of 
the tubercles themselves upon the constitution, as from the abundance of the 
excretion with the suppuration and ulceration which interferes with the pro- 
per action of vital organs. Microscopically, they differ very widely (see 
Plate III. Fig. 3). Syphilis and glanders (La Morve), which, since M. 
Kayer's researches has elicited so much attention abroad, resemble cancer in 
one point, that the constitution becomes deteriorated, but they differ in pro- 
ceeding from without, and not, as in the other, in consequence of a constitu- 
tional taint; moreover, there is not with them a particular tissue formed as a 
result of their contamination. 

M. Lebert dwells upon cancer being the substitution of an abnormal ele- 
ment for those which already exist in the body. In proportion as this new 
tissue is developed, it becomes vascular; nutrition goes on, and the histologi- 
cal healthy structures are compressed, become atrophied, and, finally, disap- 
pear. The popular belief of the possible transformation of bone, muscle, 
&c, into cancer, is totally incorrect. Such is, apparently, the case; but, in 
fact, the blastema of cancer is thrown out, and the cell and nuclei are formed 
in the primitive structure; the original elements, being gradually absorbed, 
give place to them. 

We have now arrived at what is, to us, the most interesting point in regard 
to the disease under consideration, its peculiar element, as seen through the 
microscope. Taken merely as a tissue with its coarser physical characters, 
we must all acknowledge it is sometimes difficult even for the most expe- 
rienced to diagnose it. The question upon which we have already expressed 
our firm conviction, as to whether or not there are peculiar bodies only found 
in cancer — when carefully examined, instrument in hand — is one of the 
greatest importance, both practically and for science. The objections urged, 



58 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

and the doubts expressed by many who are not familiar with microscopic 
modes of investigation, are, of course, not worthy of notice. We will, pre- 
sently, consider Mr. Bennett's views, at which we could not but be surprised, 
as we had been struck, during a recent sojourn in Paris, with the remarkable 
unity of opinion there, on this point, among men who now occupy the first 
rank in scientific matters connected with medicine, such as Rayer, Lebert, 
Ch. Robin, Claude Bernard, Follin, Broca, and others, members of the " So- 
ciete de Biologie," and of the " Societe Anatomique." We have repeatedly 
known — as have others who have enjoyed the privilege of attending the meet- 
ings of these societies, or of following the cours of some of the members — of 
the same morbid specimen being taken to them to be examined separately, 
and all to give the same opinion of them. 

Some have been rendered incredulous as to the accuracy of the microscope 
by hearing Velpeau, at his clinique, question it ; but, although he has been 
considered the first surgical pathologist of his day, yet his opinion, in regard 
to what he has himself never investigated, can scarcely be quoted as high 
authority. Would that such men would show the same magnanimity as did 
Louis in regard to the presence of a tubercular corpuscle. He would himself 
give no opinion, not being familiar with the instrument, but sought that of 
one whom he knew was, M. Lebert, from whom he gives* a note on the 
subject. 

Some are disappointed on being told that the cancer element is not always 
of a uniform size, or even of a certain fixed shape; but they certainly do not 
doubt the existence of epithelial cells because their shape, &c, is different on 
different surfaces. We will presently show that the great variety of form in 
the cancer element is a striking peculiarity characteristic of the disease. Not- 
withstanding their variable form, they all have points of unmistakable re- 
semblance with each other. Out of a hundred individuals of a particular 
race, there may not be two with precisely the same features, yet about whom 
there could be no doubt as to their common origin. To use an expressive 
French phrase, they all have their cachet particulier. 

In the accompanying plates, we have attempted to arrange (under several 
divisions), into groups, the different forms of the cancer-cell we have met 
with. In making the selection from the numerous drawings we have collected 
in our album, we have thought it better, instead of giving only the types, so 
to speak, of the several shapes under which we desired to include all the 
various modifications, to show as many as possible of the numerous varieties. 
For the rudeness of the designs themselves we ought, perhaps, to apologize, 
but they are, as far as we could make them, exact representations of what 
we saw in the field of the instrument. We will first describe the proper 
elements separately, and then speak of the objections offered by Dr. Ben- 
nett, and some others, to their distinct characters as pathognomonic of 



* Recherches sur la Phthisie, 2 ie « ne edition, Paris, 1843. 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 59 

cancer, giving drawings of other elements confounded with them. The 
points of dissimilarity we will call attention to with a view of fixing the 
differential diagnosis. The mode we have employed has been simply to 
place between two pieces of glass a drop of the juice, obtained either from 
gentle pressure, or by scraping the cut surface with a scalpel, diluted with 
a little water. The cutting off of small slices with Valentin's knife, and 
examining the whole mass together, will exhibit, almost invariably, more 
or less fibrous structure, but necessarily the lens employed must be much 
feebler, and the cell is not seen to the same advantage j moreover, the fibrous 
element is purely accidental, and is found in a vast number of tumours. The 
instrument used is a first-class one, manufactured by Nachet. The power we 
have habitually used in studying cancer element has been one of 555 diame- 
ters (Nachet's No. 6). Mr. Bennett used, in his researches, one of 250, 
which he recommends to others. We state this for the purpose of explaining 
why it is he has omitted some characters of the element which we believe are 
of great importance. The element of cancer consists of three parts, cell, 
nucleus, and nucleolus, all of which are peculiar to it. We will consider — 

1. The cancer nucleus, as inclosed in a cell, or as floating free by itself. 

2. The polygonal, or more or less spherical and ovoid cell. 

3. The caudated cell. 

4. The fusiforme cell. 

5. The concentric cell. 

6. The compound, or mother cell. 

7. Agglomerated nuclei connected by amorphous tissue. 

In all the varieties of cancerous tissue, nuclei are to be found either enve- 
loped by a cell, or floating free, generally more or less of both; in some spe- 
cimens, there exists a large number of free nuclei with only an occasional 
cell. The form and appearance of these nuclei is the most constant and 
unvarying of all cancer elements. They are (see Plate I. Fig. 1, a) 
ovoid, or more or less round; the latter are found more particularly when 
the eye or the lymphatic glands are the organs diseased. Sometimes (as in 
h), we find little pieces of the wall of the nuclei apparently nicked out, 
but evidently it is purely accidental, and the proper shape can easily be re- 
cognized. They have, ordinarily, in width, a diameter of from l-100th of a 
millimetre, or (a millimetre being equal to .039th of an inch) of .0039th of an 
inch, to l-66th of a millimetre, in one instance we met with one as wide as 
1-3 8th of a millimetre ; in length they measure from l-133d to l-100th of a 
millimetre. Their contour is dark and well defined, with the interior containing 
very minute dark granulations ; indeed, when the specimen is perfectly fresh, 
they have a homogeneous aspect, the granulations being so small as to give 
the appearance of a mere shading (see Plate I. Fig. 1, c); if the spe- 
cimen is kept a day or two, we find the interior filling up with larger granula- 
tions (as in d). Within these nuclei, when they have not been obscured 
by granular or fatty degeneration, there is found habitually a small body, or 



60 Donaldson, Application of Microscope to Diagnosis of Cancer. [J an. 

nucleolus, averaging in diameter about l-500th of a millimetre. These nucleoli 
have somewhat of a yellowish tinge, with a brilliant centre and dark borders, 
refracting light like the fat vesicles. We would call attention, particularly, 
to the peculiar brilliancy of the centres of these nucleoli, which, we think, is 
characteristic ; it can be almost invariably noticed, if the focus is varied. 
Their large size, in proportion to the nuclei, should also be noticed, together 
with the great variableness of their position, sometimes being near the centre, 
and again in close contact with the walls (see e). Ordinarily, in other ele- 
ments, they are found almost constantly in the centre. Yery frequently, two 
or three nucleoli are found within the same nucleus. M. Robin* mentions 
the action of acetic acid upon cancer nuclei and their nucleoli, as differing 
from that on other elements, particularly epithelial ; it renders the nucleus 
gradually paler, together with the cell, destroying neither — but the nucleolus 
is perfectly untouched by it ; whereas in epithelial cells, where generally in 
those of the skin the nucleoli are wanting, the action of acetic acid destroys 
the cell, leaving the nucleus unaltered. 

It is of primary importance for the proper examination of the cancer 
nucleoli that the specimen should be fresh. Such being the case, we do not 
remember ever having found these peculiarities wanting. Mr. Bennett says 
there is nothing peculiar about the cancer nucleus. But is his opinion to be 
wondered at, when, often from the low powers used, he could not see at all the 
nucleolus? The same confusion is produced by Dr. Brinton,f he having used 
a lens of 200 diameters. A high power as well as a clear definition is neces- 
sary. 

We have examined some specimens in which free nuclei were in great 
abundance, and where, after long- continued diligent search, we were unable 
to discover any cells. More particularly is this the case in cancer of the liver, 
of the pylorus, and of the lymphatic glands ; more rarely in that of the eye. 
In the breast, many full-formed cells are found with more or less of free nuclei 
floating in the blastemic fluid. It may be well to remark here that we find 
also free nuclei of fibro-plastic and epithelial cells, of the finest bronchial 
ramifications, each with their peculiarities. Mr. Bennett appears to us to 
have confounded them all together in speaking of what he calls fibro-nucleated 
tissue. 

In regard to the cells themselves of cancer, although we stated their forms 
as very variable, yet many of them are modifications of the polygonal, which 
may be considered the type. In explanation of the theory of the shape and 
size of various cell membranes, we would refer the reader to Professor 
Schwann's views ;J undoubtedly, as he supposes, the close crowding together, 
and the processes of endosmose and exosmose, may be the producing cause. 

* MS. notes of his Cours de Histologie, 1850. 
| Philadelphia Medical Examiner, Dec. 1851. 

J "Microscopical Researches into the Accordance in the Structure and Growth of 
Animals and Plants," by Th. Schwann. Sydenham Soc. edit. 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 61 

Thus we observe that in hard firm tumours, particularly those of the breast 
and ovaries, the cells found are exceedingly irregular, sometimes nearly tri- 
angular. (See Plate I. Fig. 3, f.) The ovoid or spherical are more frequently 
met with in soft or medullary cancer (see Plate L Fig. 3, g), where there is but 
little pressure, although its juice appears often to be but one mass of cells. 
It is rare, however, that perfectly round cells are met with, but very generally 
the angles are well rounded in those which appear to be derived directly from 
the polygonal form, the diameter of which is very variable, ordinarily from 
y^th to 2V th of a millimetre. One peculiarity of this, as of the other forms 
of cancer-cell, is the presence of the granulations of different sizes in their in- 
terior; whereas, in epithelial cells, the interior is generally, when fresh, of 
course, homogeneous. In cancer, we find the three varieties of granulations 
given by M. Robin fF first, the very fine black dots found in all organic ele- 
ments, and named by the French, very appropriately, poussiere organique; 
secondly, the gray granulations, a form somewhat larger ) and, lastly, the fat 
granulations distinguished by the refraction of the light. — This first variety 
of cells contains nuclei, having in their interior invariably one or more 
nucleoli, both of which retain the characteristic points described above. The 
large size of the nucleus, in proportion to the diameter of its cell, will 
at once strike the eye of the careful observer. The variable position, also, of 
the nucleus within the inclosure, appears to us to be peculiar to cancer ; in 
cells of other structures, the rule is to find the nucleus very nearly in the 
centre, except with fibro-plastic cells, where the nuclei appear to have a pecu- 
liar affinity for the walls. All varieties of cancer cells contain very frequently 
two or more nuclei ; whereas, the epithelial, more particularly those found 
on the surface of the body (where there is most danger of confusion and 
doubt), but rarely have more than one. Moreover, the cell of epithelium is 
much larger than that of cancer, yet the cancer nucleus is twice as large as 
that of epithelium, as is also the nucleolus, compared with that found in epi- 
thelium. 

Oaudated Cells. — This variety of cancer element appears to be considered 
the cancer-cell by persons unfamiliar with the microscope. The French pa- 
thologists speak of it as la cellule en raguette. (See Plate I. Fig. 2.) Its 
general aspect is the same as that of the preceding, the only difference 
being the prolongations, one, two, or three in number, branching off from the 
body (so to speak) of the cell; sometimes there are as many as five projec- 
tions. There is no regularity about them, as the reader may perceive in the 
plate ) indeed, they frequently take the most grotesque shapes. 

This form is met with more or less in all cancerous tumours, but invariably 
in those of the bladder ; cancerous degeneration of the parotid often contains 
them in considerable abundance. 

Fusiform Cancer-Cells. — (See Plate II. Fig. 1.) This shape is caused by 



* Tableaux d'Anatomie, &c, par Ch. Kobin. Paris, 1851. 

No. XLIX —Jan. 1853. 5 



62 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

a swelling in the centre, with the ends pointed, forming often a very acute 
angle. It is found mixed with the other forms in all parts of the body; but 
always more numerous in cases where the disease has attacked the bones. M. 
Robin* says that he has never examined cancer of the bones without finding 
this variety. It is this form which Mr. Bennett confounds with fusiform 
fibres of fibro-plastic tissue (see Plate III. Fig. 4), making no distinction 
between them, but describing them together under the name of fusiform cor- 
puscles. Except some similarity of shape, we cannot see how they could be 
mistaken for each other. We ask the reader to compare the drawing of these 
two things, and he will at once see that the cancerous is double in width and 
length; moreover, its nuclei are much larger, and the nucleolus is much 
smaller in the fibro-plastic, where the absence of the clear bright centre, &c, 
may be noticed. 

The Concentric Cancer-Cell (see Plate IT. Fig. 2) is formed of an ovoid or 
spherical body, surrounded by concentric rings, so as to give the peculiar ap- 
pearance of circles around a centre, increasing in size as they get further out. 
The centre resembles in every respect the ordinary cancer nucleus, and some- 
times other nuclei appear between the circles, and occasionally a nucleus is 
seen pressing against the outside of the cell wall. It is not known how this 
variety of cancer constituent is formed, and we forbear giving any of the 
conjectures in regard to them. Sometimes a mass of epithelial cells are 
pressed together, and present somewhat this appearance. This cell is met 
with but rarely, and but few in a specimen ; it is more likely to be seen, 
says M. Robin, in the uterus, breast, and ovaries, than elsewhere; it never 
forms the basis of the tumour, but is merely accessory. According to Robin, 
it exists more frequently in the form of cancer tissue, which, in consistence, 
is between schirrous and encephaloid. 

Having ourselves but one drawing of a distinctly marked specimen of this 
cell, we borrow for our plate one from M. Lebert.f 

The Compound or Mother- Cell of Cancer (see Plate II. Fig. 4) is of very 
variable shape, as the drawings show. They have received this name from 
the views entertained by some authors, more particularly Kiiss and Bruch, of 
their splitting up into smaller segments and multiplying by division. They 
contain often three, four, or more cancer nuclei. We ourselves have never 
seen more than seven within one cell, although Lebert gives a drawing of one 
containing as many as nine. Some consider that secondary cells are formed 
within the parent one, and are let out by the rupture of the outer wall. It 
is, however, mere conjecture. — The last form in which these elements are 
exhibited is where a number of nuclei appear to be glued together, as it were, 
by the amorphous blastema in which they are generated, without there being 
any recognizable cell wall around them. M. Robin J calls them plaques d 

* MS. Notes of his Cours d'Histologie, 1850. 

| Physiologie Pathologique. Atlas, Plate XVIII. 

J Tableaux d'Anatomie, 1851. 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 63 

noyaux multiples. The size of the envelop about them prevents them from 
being confounded with anything else. These agglomerated nuclei (see Plate 
II. Fig. 3) are nearly as rarely met with as the concentric cell. 

All these varieties of cancer element can be seen in the same specimen, 
although, as we mentioned in speaking of each, they have separately organs of 
selection. Cancer cells, of course, like homomorphous elements of the organ- 
ized animal or plant, have their periods of growth, and development, and 
decay; their progress to maturity may be sometimes arrested, and account to 
us in some measure for the great variety of appearance, structure, and size. 
For some interesting remarks, in regard to the retrograde metamorphosis of 
all tissues, both normal and pathological, we would refer the reader to an 
article by Dr. Burnett.* 

Out of the body, cancer elements change very rapidly, more so than 
any one element we have met with. Often, in the course of the first 
day, they become degenerated by the appearance of fatty granulations, 
which often hide their distinctive characters. Unfortunately, they cannot be 
preserved in any fluid. Alcohol coagulates the albuminous cell wall. Mixed 
up with what we have designated cancer elements are often found crystals of 
cholesterine and of triple phosphates of ammonia and magnesia, filaments, fat 
globules, crystals of margarine, pus (see Plate II. Figs. 5 and 6), &c. Wherever 
there is inflammation, especially of a chronic character, we are apt to find fibro- 
plastic elements; consequently, we must not hastily conclude, because we find 
them in a tumour, that there is nothing else there. The importance, there- 
fore, of examining thoroughly, as far as possible, each portion of the speci- 
men, cannot be, urged too much. If but one cancer-cell be found, it is con- 
clusive. That which has been designated melanotic cancer, is merely a mix- 
ture, with true cancer elements, of free pigmentary granulations, or of the 
peculiar cells of pigment. 

"We have already given our belief as to whether or not these elements are 
so characteristic that none others, either normal or pathological, can be con- 
founded with them. Some authors of high standing have asserted that such 
is not the case. Vogel admits that the cancer element is sometimes character- 
istic; but, judging from his drawings, we should say he used the same power he 
did in examining the triple phosphates, 90 diameters. Dr. Walshe, in his other- 
wise complete monograph, devotes but little attention to the histological arrange- 
ment under the microscope. Mr. Bennett is the most serious opponent to the 
diagnosis of cancer by the use of the microscope. With all due regard for one 
so eminent in the scientific world, we are forced to state the impression a care- 
ful perusal of his work has left upon our minds — that he repeatedly contra- 
dicts himself. In some places, he gives the characteristic appearance of the 
cancer element, which he so names, and then again he speaks of epidermic 
cells becoming cancerous. In one place, he speaks as though the appearance 



* American Journal of the Medical Sciences, July, 1851. 



64 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

lie admits generally found in cancer was merely a state of development of 
normal elements. He says, in part of his treatise, that such and such cells 
are characteristic of cancer, and then, afterwards, of epithelial cells steeped 
in water, resembling, in every particular, cancer-cells, and of young epithelial 
cells also being indistinguishable from them. He concludes by drawing the 
diagnosis of cancroid growths (the signification of which he has extended so as 
to destroy the definition given to it by Lebert, who invented it) as not con- 
taining the cancer element, and yet he denies there is any cell, &c, only 
found in cancerous growths ! We give, however, that others may compare 
them, the histological elements with which Mr. Bennett thinks cancer can be 
confounded. 

In regard to epithelial elements, we give (Plate III. Fig. 1), young epithelial I 
cells from Lebert' s plate, and we think it unnecessary even to call the atten- 
tion of the reader to the general aspect of the cell, the proportion the nucleus 
bears to the cell, the absence of any nucleolus, &c. ; the other varieties, ordi- 
nary tessellated scales (Fig. 2), cylindrical and ciliated (Fig. 4), could scarcely 
be mistaken for any other element. We draw (Fig. 9) pavement epithelial, 
seen with the same power we used with the cancer elements. 

Fibro-plastic elements possess a peculiar interest in being the only ones 
where there is any ground for seeing a resemblance to cancer elements. They 
were first defined by M. Lebert, who thought them always the product of disease. 
Further researches have convinced him that such is not the case. In the 
healthy subject, they are found in the bladder, ovaries, liver, mammary gland, 
uterus, &c. According to Robin,* the internal membrane of the Graafian 
vesicle is the only membrane, in the state of health, which is formed altogether 
of'it. The discovery of them in the uterus is due to M. Robin, who has con- 
firmed M. Coste's interesting researches in regard to the hypertrophy of the 
uterine mucous membrane during the evolution of the Graafian vesicles, and in 
regard to the same membrane forming the coverings of the foetus, known as the 
decidua vera and rejiexa, by finding that the fibro-plastic cells, as one of its 
habitual elements, actually become larger as the first stages of pregnancy ad- 
vance. f It is, moreover, fibro-plastic tumours which are the true sarcomatous 
ones, and which are so frequently confounded with cancer. Their slow growth, 
the absence of the cancer juice, their return after the operation in situ, but not 
elsewhere, showing there is no constitutional taint; their being frequently 
encysted, which cancer never is; their carnified consistence, and their having 
the cellular tissue^ aS their point of departure, and generally not organs, are 
important diagnostic signs. 

We give the true fusiforme corpuscle (Plate III. Fig. 4) of this tissue, the 
length of which is often as much as from t l th to ^-st of a millimetre. The nar- 
rowness of their width, the smallness of their nuclei, the nucleolus, and, indeed, 

* MS. Notes of his Cours d'Histologie, 1850. 

•j- See Traite Pratique des Accouchments par Cazeaux, 3ieme edit. Paris, 1850. 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 65 

the whole aspect, would prevent, we should think, any one who is familiar 
with microscopic investigations, from confounding them with anything else. 
The fibro-plastic cells and their free nuclei (Fig. 5) could be mistaken for can- 
cer by a superficial observer. They are ovoid, and sometimes polygonal, vary- 
ing in diameter from- ^^.th to ^th of a millimetre. The appearance, however, 
of the nucleus itself with the nucleolus, differs very widely from cancer, the 
granulations in their interior are very much finer, and of more uniform size 
than those found in cancer. The free nuclei of fibro-plastic tissue are so 
much smaller as to be easily known when met with. 

But the strangest comparison we find in Mr. Bennett's book is between 
cancer and cartilage elements. Since Muller's articles on enchondromatous 
tumours, the attention of pathologists has been much turned to their inves- 
tigation. Had we the time and the space we would describe particularly the 
elements of cartilage, which compose this class of morbid growths, and which 
are as clearly marked as striated muscular fibre or any other histological element. 
Suffice it now to remark that within a homogeneous structure, composed princi- 
pally of gelatine, and called hyaline, are found excavations or cavities measur- 
ing often more than one-twentieth of a millimetre, more or less of an irregular 
ovoid shape, with cells (not corpuscles as was formerly supposed), generally 
of one-fiftieth millimetre in diameter, which contain a nucleus often filled with 
fatty granulations, so as to destroy the nucleolus. The hyaline structure 
invariably accompanies them, and bounds them on all sides ; this has been 
considered so characteristic of cartilage as to preclude all danger, independent 
of the form of the cell, of its being mistaken for anything else. 

Mr. Bennett tells us, that when enchondromatous tumours become softened, 
and the cells escape from the cavities they resemble very closely cancer. It 
has never been our good fortune to meet with any such cases, but we confess 
we cannot understand how, even if the cells were free, they could be 
taken for those of cancer. Compare them (Plate III. Figs. 7 and 8) with any 
or all of the varieties of cancer element (Plates I. and II.), and remark the 
difference of shape, &c. 

In Plate II. Fig. 5, we give a drawing of pus, before the addition of any 
reactive, and, in Fig. 6, we give the same corpuscles, acted upon by acetic 
acid. It will be noticed that with a high power, frequently a dim outline of 
the nuclei can be seen when the corpuscles are unmixed with any reagent. 
We are glad to have the support of Bennett and Robin in stating that there 
is no mucus-corpuscle. What has been so called was either pus, so easily 
produced on mucous membranes, or epithelial nuclei. 

Thinking it would be not uninteresting to the reader to compare the element 
of tubercle with that , of cancer, we give (Plate III. Fig. 3) several cor- 
puscles found in a specimen of softened tubercular lung handed to us while 
copying off these remarks ; from the first preparations examined we could 
have given almost any number, but the few we have drawn are perfect type 
specimens. 



66 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

A few words in conclusion, in regard to the development of cancer. We 
forbear saying anything of the absurd theories of its being produced by 
infusoria, &c. Of where and how it originates we must acknowledge our 
ignorance. That the materies morbi, whatever it may be, is propagated by 
the blood it is rational to suppose ; but certain it is, the element of the dis- 
ease is never there found, no matter how contaminated the whole system may 
have become. We think that M. Lebert has proved, in his researches on in- 
flammation,* that pus, inflammatory corpuscles, pyoid globules, &c, are never 
formed within the bloodvessels, but entirely external to them in the effused 
liquid ; indeed, even the three blood globules are too small to exude through 
the coats of the capillaries; the red colouring matter, the hematine, may dis- 
colour the effused serum; but if any blood-globules, even to the minute globu- 
line, are discoverable, there must necessarily have been a rupture. This fact 
is one of vast importance in questions of pathology in regard to the absorp- 
tion of pus, &c. The cause of the development of cancer is still inexplicable, 
but we know that in the nutritive material thrown out there is cancer blastema 
mixed up with it, and that the elements of cancer are formed together with 
those of the organ or tissue where it is developed. After this, the cancer 
tissue is nourished as are the healthy structures. 

Dr. Walshe carries out Schwann's cellular theory in regard to cancer to its 
greatest extent, and thinks cancer is propagated by the generation of cells 
from cells, but his conclusion was a theoretical one. We need not apolo- 
gize for quoting so frequently M. Lebert, who states that after having 
carefully for years examined, both before and since the publication of 
Schwann's work on embryonic cells, the cells, &c, of the adult in the healthy 
tissues, and in morbid products, he is convinced that, in morbid tissues espe- 
cially, each and every cell, fibre, &c, is formed separate and apart from the 
cancer or other matrix, or blastema. Thus a new deposit of blastema is 
necessary to give rise to new cells. At first a small nucleus is formed, which 
becomes larger and larger, then, gradually a nucleolus is formed in the centre, 
and the whole is enveloped in a cellular wall, which swells out by endosmose, 
until it reaches the usual type, size, and form. It can become deteriorated 
by diffusion, by rupture of its walls, from internal granulations, either moli- 
cular or fatty, by atrophy, &o. In this way, the cells are formed from the 
matrix, and not from direct cellular generation, and disappear, and are not, 
and cannot, indeed, be taken as such into the circulation. 

There is, perhaps, no doctrine or statement in medical science, which has 
had so universal an acceptance as that of M. Schwann's, in regard to cell- 
formation; with him, all the tissues must necessarily, both vegetable and 
animal, pass through the transition state of cells. All, it appears to us, will 
be surprised, if they read Schwann's work itself, to see upon how slender a 
foundation he erected such a superstructure, as the universal application to the 



* See Physiologie Pathologique, t. i. 



1853.] Donaldson, Application of Microscope to Diagnosis of Cancer. 67 

tissues of all kinds and sorts, of the cellular theory of formation. Henle 
believes that nuclei are the primitive elements formed. 

But we have what to us is the highest authority against the entire adoption 
of Schwann's views as applicable to all organisms in the researches of MM. 
Lebert and Robin. In a recent publication by M. Robin,* he defines with 
his usual clearness the doctrines professed by him on this subject. He says 
that strictly speaking there is great misapplication of the term cell, which is a 
small body with a wall, a cavity, and a contents. This exists in most of the 
vertebrata only during embryonic life, when the being is composed entirely of 
cells. When it becomes a foetus, fibres, tubes, &c, form; cells, properly speak- 
ing, disappear, and together with the fibres, &c, a flat body is formed, to which 
the term of cell is generally applied, which is a mass of the same density in 
the centre as at the periphery, without a true wall or a contents, with a nucleus 
in the centre. There are, however, some few exceptions to this; in certain 
glands the elements retain their walls, cavities, and contents ; this is more par- 
ticularly the case in invertebrated animals. M. Robin, then, acknowledges that 
the cellular theory is true, so far as it relates to the fact that all animals and 
vegetables derive in the first instance their structures from cells; that is, that 
they are born from cells which are formed by the segmentation of the yolk of 
the egg. These cells, however, are transitory, properly speaking, embryonic? 
because they there end, and are destined to be replaced by permanent elements; 
in the human subject, the embryonic life only continues until the eleventh day 
after conception. So far Schwann's view holds true ; the animal is during embry- 
onic existence as the vegetable; but the originator of this beautiful theory 
would carry his doctrine much further, even into foetal and adult life. M. 
Robin professes that, during and after foetal life, there is one of two processes 
in the formation of the elements of the tissues, organs, &c. : either there is a 
direct metamorphosis of the embryonic cell by a change in its form, volume, 
consistence, &c, into anatomical elements, such as cells of the epidermis, &c, 
or else there is a substitution of entirely new elements for it, which are 
formed altogether independently of it in a new cytoblastema. 

This process of metamorphosis is universally true in the vegetable world, 
but only in the animal as regards what he calls les produits;^ that is, those 
parts, which although derived from the tissues themselves and capable of 
being reabsorbed, are yet not part of, nor essential to them ; that is, those 
which have merely a vegetable function, including therein more than we 
express by secretions and excretions. Some of these produits are destined to 
be at once ejected without serving any purpose in the economy, such as the 
urine, the feces, the sweat, &c. Others of them, on the contrary, as the 

* Supplement au Dictionnaire des Dictionnaire de Medecine, article Osteogenic 
Paris, 1851. 

f See Preface to "Du Microscope et des Injections, &c." By Ch. Robin. Paris, 
1849. 



68 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 

saliva, gastric juice, bile, pancreatic secretion, the sperm, the epithelium, &c, 
are needed, and are used by the system for the protection of the body, pre- 
servation of the species, promotion of nutrition, &c. In these, there is a 
transformation of the true commencing cell into new elements. 

Les constituants, the tissues themselves; that is, those parts which have 
animal as well as vegetable functions, are formed by the second process, the 
substitution of new and permanent elements for the transitory or embryonic 
cells, which disappear entirely. In one word, a new matrix is effused in which 
there is a spontaneous generation of new elements in each tissue, the old 
being dissolved or reabsorbed, and playing no part in the new formation. 
This mode of formation by substitution exists only in the animal, and with it 
merely in regard to the constituents of their tissues ; these elements are of a 
permanent kind, and are generally in the form of tubes, fibres, homogeneous 
uniting tissue, &c, and but rarely of cells; the reverse of this is the case with 
les produits. 

M. Lebert, in his researches on inflammation, watched very closely under 
the microscope in wounds of animals the formation of fibres, cellular tissue, 
&c, and he tells us that they acquired immediately their permanent shape 
without going through any cell stage. True muscular fibre cannot be repro- 
duced after foetal life. 

These three orders of facts, it will be remarked, are very closely linked 
together. 

The cellular theory is true of embryonic life for both vegetables and 
animals. 

The theory of transformation is applicable to the formation, during foetal 
and adult life, of all the elements of vegetables, and merely to those parts of 
the animal which have only vegetable functions to perform. 

The theory of substitution applies in no particular to the vegetable kingdom, 
but solely to the formation of the anatomical elements of the animal tissues. 

We hope the reader will paidon our prolonging this paper by this digres- 
sion, but we felt grateful to M. Eobin for giving the right direction to, and thus 
modifying, after devoting years to the investigation of the phenomena of the 
formation and growth of our tissues, the extravagant theory of Schwann, 
which some have thought almost explained all the phenomena of life. We 
say we felt so much indebted to him for all these and many other valuable 
truths communicated by his works and orally, that we could not forbear giving 
these beautiful results to the lovers of science in this country.* 

* Since writing the above, our attention has been drawn to Dr. Pope's translation, 
in the September number of the St. Louis Medical and Surgical Journal, of M. Broca's 
thesis. 



Baltimore, October, 1852. 



PLATE L] 



[Am. Journ. of Med. Sci., N. S., vol. xxv. 




PLATE II.] 



[Am. Journ. of Med. ScL, X. S., vol. xxv. 




1853.] Donaldson, Application of Microscope to Diagnosis of Cancer, 69 



EXPLANATION OF PLATES. 
PLATE I. 

[ALL THE GANGES ELEMENTS IN THESE PLATES ARE MAGNIFIED 555 DIAMETERS.] 

Fig. 1. Free cancer nuclei; a, type form ; b, the same -with a piece nicked out of the 
side accidentally ; c, shows a free nucleus, in which the molecular granules are 
very minute, often met with in perfectly fresh specimens ; d, a nucleus, in which 
larger granules have commenced to form ; e, the characteristic nucleolus with its 
dark contour and bright centre ; h, fine molecular granules ; i, the second variety 
of granules, or gray granulations ; j, fat granules. 

Fig. 2. Caudated cancer-cells ; m, the most usual forms : n, cells containing double 
nuclei; cancer of the bladder invariably contains this variety. 

Fig. 3. Forms of cancer-cells derived from the polygonal or type variety ; g, spherical 
cells ; a, dark contour of inclosed nucleus ; e, the nucleolus ; k, a nucleus with 
its contour pressed out of shape ; I, a form of cell frequently seen, where there is 
a deficiency of part of the wall ; /, from pressure rendered triangular. 



PLATE II. 

Fig. 1. Fusiform cancer-cells, found in great abundance in cancerous disease of 
bones ; a, the nucleus, which, in this variety of cell, is almost constantly ovoid. 
The transverse diameter of the cell and the size of the nucleus in proportion to the 
cell, together with the characteristic nucleolus, distinguish this variety from the 
fusiform nbro-plastic element. 

Fig. 2. Two concentric cancer-cells; a, the cancer nucleus, the size of which is 
always in proportion to the innermost circle ; e, the brilliant nucleolus. 

Fig. 3. Agglomerated nuclei: a, nucleus; p, amorphous xiniting tissue. 

Fig. 4. Compound cancer-cells, containing three or more nuclei ; a, nucleus ; when 
there are more than one nucleus vrithin a cell they are smaller than the single 
nuclei ; o, from Lebert. 

Fig. 5. Pus corpuscles, magnified 833 diameters ; q, type form before the addition 
of any reactive ; r, outline of nucleus seen surrounded by thick granulations. 

Fig. 6. The same after the application of acetic acid; s, the irregular contour of 
the corpuscle freed from the granulations, leaving the nuclei clear ; t, cha- 
racteristic nucleus without any nucleolus ; u, free nuclei, the walls having been 
destroyed. * Diameter of pus-corpuscle varies from l-100th to l-80th millimetre, 
that of the nucleus l-333d ; v, remnant of contour. 



70 Donaldson, Application of Microscope to Diagnosis of Cancer. [Jan. 



PLATE III. 



Fig. 1. Young epithelial cells (from Lebert's plate) ; w, cell-wall filled with few and 
small granules ; x, the nucleus, very small in proportion to cell, and containing no 
nucleolus. 

Fig. 2. Tessellated epithelium; y, nucleus without nucleolus, diminutive in propor- 
tion to cell ; z, the cell with homogeneous minute granulations filling up the centre. 
Diameter of the cell when taken from the skin 1-1 0th millimetre. 

Fig. 3. Corpuscles of tubercle (833 diameters) ; 1. corpuscles found in softened tuber- 
cular matter; a small irregularly formed globular body with neither nucleus nor 
nucleolus, measuring l-142d millimetre in diameter: 2, interior granulations; 3, 
free loose granulations. 

Fig. 4. Fusiform corpuscles of fibro-plastic tissue: 4, the narrow and long fusiform 
cell, containing a nucleus (5) with a small dot in its centre for a nucleolus ; ave- 
rage length of cell l-12th millimetre. (Magnified 555 diameters.) 

Fig. 5. Spherical fibro-plastic cells, found in the uterus and in other organs in the 
healthy subject ; also as the result of chronic inflammations ; and forming, with the 
preceding variety, the basis of true sarcomatous tumours ; 6, well marked cell ; 7 
and 8, nuclei inclosed in cells or floating free ; transverse diameter 1 -200th milli- 
metre. 

Fig. 6. Cylindrical and ciliated epithelial elements, found in the nasal fossae, trachea, 
Eustachian tubes, in the intestinal canal below the cardiac orifice ; 9, hair-like 
extremities, which, during life, are constantly in motion ; 10, nucleus clear in the 
centre. 

Fig. 7. Cartilage elements taken from the condyles of the femur ; 13, hyaline tissue ; 
14, excavated cavity; 15, cartilage cell; 16, nucleus; 17, nucleolus very fre- 
quently drowned by the fatty granulations. 

Fig. 8. Costal cartilage; 18, hyaline substance; 19, cartilage cavity; 20, cell; 21, 
nucleus. 

Fig. 9. Buccal epithelial scales, magnified 555 diameters, to show more clearly their 
dissimilarity to cancer elements; 11, irregularly polygonal contour; 12, the cha- 
racteristic nucleus without any appearance of a nucleolus, which is rarely met 
with in epidermic cells, or in those coming from the buccal surface. 



1853.] Morland, Extracts from Soc. for Med. Improvement. 



71 



Art. IY. — Extracts from the Records of the Boston Society for Medical 
Improvement. By Wm. W. Morland, M. D., Secretary. 

May 24. — Extroversion of the Bladder, with unusual Complications.* — Dr. 
Jackson exhibited the specimen, taken from a patient of Dr. Homans's; 
child born at the full period, but died in a few hours ; the bladder presents 
the usual red, irregular surface ; the cord being inserted at its upper extre- 
mity. Opening of the ureters free. Kidneys well developed; but the left is 
situated quite low in the abdomen. The small intestine is forty-five inches in 
length, and opens freely upon the surface of the bladder, forming a very marked 
projection, which the friends mistook for a penis, and accordingly christened 
the child " John." Just below this opening there is another, from a very 
anomalous organ, which, it is supposed, may be a portion of undeveloped 
intestine, consisting of a tube about two and a half inches in length, very 
much resembling the appendix cseci, and being closely adherent to the inside 
of the pelvis; from this tube and towards its outlet, there are sent off/ two 
others, nearly half an inch in length, the common trunk of the three being 
about three lines in diameter; the parietes of these tubes were quite as thick 
as those of the large intestine should be ; the inner surface was not peculiar, 
and the cavity was filled with very tenacious and nearly colourless mucus ; the 
external opening was large, and traversed longitudinally by a well-defined, 
fleshy band. The testicles were well developed, and situated about at the 
brim of the pelvis ; vasa deferentia traced down behind the organ last de- 
scribed. Grlans penis situated at the lower margin of the bladder, and so 
small as to be hardly recognizable. Ossa innominata seem to be fully deve- 
loped, but are separated at the symphysis to the extent of one and a half 
inches. 

Spina bifida. Between the thighs were two tumours which would suggest 
the idea of a double hydrocele ; one of them being about the size of a small 
orange, and the other equal to a large nutmeg, with a marked raphe between 
them; flaccid, encysted to the feel, and covered by integument, as spina 
bifida is when situated over the sacrum. The parietes of these cysts consist 
of cutis externally, a lining of serous membrane internally, and a loose inter- 
vening cellular tissue, but no fat ; the two communicating freely, and there 
being a third that did not show externally. The cavity contained some 
ounces of clear yellow serum. Towards the upper extremity of the large 
cyst was an opening, through which a probe was passed and came out in the 
lumbar region between the spinal marrow and the membrane immediately 
investing it. The wings of the vertebras having been cut away, the spinal 
marrow is seen to continue in substance down to the opening in the cyst; the 
very termination, however, being softened by cadaveric change, and probably 
by the passage of the probe. Sacrum somewhat deficient, as usual in these 
cases. 

Organs otherwise well formed. Dr. J. remarked especially upon the fact 
of the spinal marrow being continued in substance down below where the 
cauda equina is usually formed in these cases of spina bifida in the sacral re- 
gion, and of which there are already two specimens in the Society's cabinet ; 
a fact which is particularly insisted upon by Cruveilhier, and stated by him to 
have been known to Morgagni. 

* Omitted in the "Extracts" for July Number of this Journal. — W. W. M. 



72 



Morland, Extracts from Soc. for Med. Improvement. [Jan. 



July 26. — Abdominal Abscess. — Reported by Dr. Hayward, Sen. Dr. 
H. visited a boy, fourteen years of age, about the middle of June, and found 
him suffering from some obscure trouble in the abdomen. Ten months pre^ 
viously, he had run a race of a mile with another boy, which was followed by 
great fatigue; the subsequent symptoms have been variable; the patient was 
much emaciated, the pulse small ; abdomen tumid ; there were night-sweats. 
A protrusion was observed at the umbilicus ; puncture, with the exploring 
needle, discovered a purulent collection, which, to the amount of a quart, was 
evacuated; the pus was very fetid; its discharge procured the patient imme- 
diate and great relief; he had not been able to raise himself up without great 
pain for some time previous to the operation. Dr. Hayward supposed the 
case to be one of subacute peritonitis. 

October 18. — The patient is now nearly well; he may, in fact, be consi- 
dered entirely so, as nothing remains of his former difficulty, except a slight 
discharge from the orifice at which the pus was drawn off. 

August 9. — Dr. Storer read from his note-book the following case of 
Removal of a retained Foetal Head : — 

4th. Was called at 5 o'clock P. M. to consult with a physician under 
the following circumstances: He was sent for at 6 o'clock A. M. to at- 
tend a case of labour. Finding an arm presenting, after much difficulty he 
turned the child, and brought down a leg. At 12 M. he had succeeded in 
delivering both lower extremities; and at 2 o'clock, the entire child, with the 
exception of the head, was delivered. Not being able to extract the head, he 
called to his assistance another practitioner; together, they made such trac- 
tion as they thought justifiable, without producing the desired result. Hav- 
ing produced a luxation of some of the cervical vertebrae, and consequently 
unable to use any more force, they severed the body from the head to enable 
them the more readily to apply their instruments. As soon, however, as the 
head was separated from the body, it receded into the pelvis, and their efforts, 
continued for a long period, to fix and remove it, availed them nothing. 

I found the woman much less exhausted than would have been imagined, 
with a tolerably good pulse, and not depressed. 

The head could be reached only by passing the entire hand into the uterus, 
and could scarcely be retained in any one position by pressure being applied 
over the abdomen. The uterine contractions were so great that I several 
times removed my hand, perfectly useless by the pressure which had been 
applied to it — and I should have given up in despair of being able to remove 
the head, had I not felt that nothing should be left undone which could be 
attempted without additional risk to the mother. At last, I was able to pass 
the index finger of my left hand into an orbit ; along this finger I introduced 
Smellie's scissors, and was so fortunate as to be able to pass them through 
the orbit into the brain. The distance of the head from the external passage 
may be judged of from the fact that, when the instrument was in the brain, its 
handles were not visible externally. After the contents of the cranium were 
removed, and the bones had collapsed upon each other, it was extracted by 
the hand without much difficulty. 

The attending physician found some obstruction to the removal of the pla- 
centa from an irregular contraction of the uterus, and from its partial adhe- 
sion. 

To an accoucheur who has never been called upon to perform the operation 
just described, the process may appear a very simple and easy one. But this 
is very far from being the case. It is an exceedingly difficult matter to have 



1853.] Morland, Extracts from Soc. for Med. Improvement. 73 

the bead retained in any one spot with sufficient force to perforate, should it 
be thought advisable; the scissors are constantly found to slip upon the 
cranium, beneath the scalp, and it may be a long time before the hook can be 
applied where it will retain a permanent hold. 

Conquest observes, as if the operation were not a difficult one, " when this 
occurrence has taken place, it is necessary to have the uterus fixed, by the 
steady pressure of an assistant, on the abdomen, while the accoucheur proceeds 
to extract the head. This may be done by the long forceps, or by fixing the 
craniotomy-forceps, crotchet, or blunt-hook, in the foramen magnum; always 
accommodating the head to the largest diameter of the pelvis during the 
extraction." By others, the difficulties are thus portrayed. Velpeatj says : 
" At the superior strait, the operation is often found to be one of the 
utmost difficulty, and appears to be even impracticable, when the womb is 
scarcely contracted, and the face and occiput are not yet engaged." — 
Jewell, in the London Practice of Midwifery, remarks: "In some instances 
it happens that the head is entirely separated from the body, when various 
means have been recommended for bringing it away ; one way is a purse, one 
extremity of which, spread out on the hand, is so carried up into the vagina, 
and laid round the head, that it shall include the whole; by which means it 
is to be brought out. Another, is by the assistance of instruments, various 
descriptions of which have been recommended; these instruments may be 
considered as just so many contrivances to catch the head, as we catch a bird 
by putting salt upon its tail. If we get the instrument on, we may catch 
the head ; and if we get the salt on the bird's tail, we may catch him, too. 
The way to extract the head is to open it, and when we have dilated it by the 
perforator, we should introduce the crotchet before we withdraw the perfora- 
tor, in order to have the head always secure from slipping, as it otherwise 
would do. The difficulty is this, that whenever we touch it, we have a smooth 
slippery surface which we cannot keep, unless we always have an instrument 
within that hole which we have made ; it will roll over the upper aperture of 
the pelvis." 

Smellie has collected ten cases in which the head was retained in the 
uterus after the delivery of the body of the child. Four of these cases he 
saw in " consultation" — all of them occurring in the practice of midwives. 
Two of the remainder occurred also in the practice of midwives, and were 
reported to Smellie by the physicians called upon for advice. 

In three of the four cases to which Smellie was called, the body appears to 
have been separated by force ; in the fourth, the head was separated by in- 
cision. Each case was terminated by the crotchet; in two of the cases, where 
the child had been dead previous to the labour, the operation was performed 
with comparative ease. After minutely describing the case in which the head 
was severed from the body, Smellie adds: " This should be a caution to prac- 
titioners, never to separate the body from the head, if possible to deliver 
without using that expedient; but to wait with patience (when the child can- 
not be saved) the efforts of the pains, especially if the woman is not in abso- 
lute danger; for the head is much easier delivered with the crotchet, when 
not separated from the body." 

Of the remaining four cases cited by Smellie from other authors, one deserves 
a passing notice. He observes, a case is mentioned in the Supplement to La- 
motte's Treatise, " in which a gentleman could not deliver the head, which 
was separated from the body and left in the uterus. Nevertheless, he went 
to bed; and the first news he heard in the morning was that the head 
was delivered by the mere assistance of nature." Most probably the child 



74 Morland, Extracts from Soc. for Med. Improvement. [Jan. 

was dead previous to the labour, and decomposition had somewhat advanced, 
else it would be difficult to account for its unaided expulsion. 

In another of these four quoted cases, Smellie says : " Dr. Grange, of 
Hatfield, told me of a case in which he and 3Ir. Wilson, of Enfield, were 
fatigued a whole day, in delivering a head, which was so slippery, that, for a 
long time, they were not able to open, or fix an instrument upon it." 

Dr. Ramsbotham (Francis H.), has met with but one case, which occurred 
in the practice of a midwife; there was a tumour in the pelvis, which increased 
the difficulty of the case. With the assistance of his father, the head was 
perforated at the sagittal suture, and extracted. 

9th. Five days after delivery. Dr. Storer's patient has not a single unplea- 
sant symptom ; and says she feels much better than she did five days after 
the birth of her former child. 

Carcinomatous Disease of the Uterus and Vagina. — Dr. Williams reported 
the results of a post-mortem examination of a case of some years' standing, 
which terminated fatally three months only after delivery. After the disease 
had been pronounced to be cancer of the womb, by her attending physician, 
the patient placed herself under the care of a midwife, who promised a cure, 
saying that "she had cured many such cases, but the physicians did not 
understand them, as they had no such organ themselves. " Finding herself 
unable to prevent the hemorrhage, which occasionally occurred, she soon 
abandoned the field. The autopsy disclosed extensive destruction of the 
vaginal and uterine parietes. Dr. W. remarked, that it is worthy of notice 
that pregnancy should have gone on well, and parturition occurred without 
accident, while the reproductive organs were so extensively involved in dis- 
ease, and that rupture into the peritoneal cavity might very easily have hap- 
pened, previous to her death, by the application of any force — such as an 
examination by the speculum — ulceration having so deeply destroyed the 
tissues. 

Dr. Jackson said he had frequently examined patients in whom such 
rupture seemed very imminent. He had not met with actual perforation in 
his own dissections of these cases, but practitioners should be exceedingly 
cautious of instrumental vaginal examination in such patients. 

Fatal Disease with Obscure Symptoms. — The following case, from Dr. 
Salter, was reported to the Society by Dr. Coale. The patient was a book- 
binder, fifty-one years old; he has generally had good health; the only severe 
illness he has experienced, within his recollection, was an inflammation of the 
lungs, in 1836, when he was confined to his house and bed for nearly three 
months, under the care of Dr. Henry Gr. Clark. Since that attack, he 
thinks he has not been quite so strong as previously. Especially on the 
approach of every autumnal season, he would be affected with diarrhoea, 
lasting about twenty-four hours ; and even during the summer season, when 
there was any sudden and decided change from heat to cold, he was almost 
sure to be affected with this diarrhoea for some hours. Besides this, during 
the winter months, he always experienced considerable oppression in his chest, 
unattended, however, by cough or pain. This oppression always left him on 
the approach of the warm season, and he continued quite well until the return 
of autumn, excepting on sudden changes of weather, as above mentioned. 
This was the usual routine from 1836 to 1852, with only one exception. In 
the latter part of the summer of 1850, he had an attack of mild dysentery, 
which did not oblige him even to keep entirely from his work, being easily 



1853.] Morland, Extracts from Soc. for Med. Improvement. 



75 



controlled. It continued about two weeks. On the approach of the spring 
of 1852, he did not recover his usual elasticity and spirits. 

On Thursday, July 22d, he called on Dr. Salter, but not finding him at 
home, left a request to be visited at his own house. Dr. SL, on calling, ascer- 
tained that his patient had not felt quite as well as usual since the month of 
April last, though in this respect his feelings were quite variable. He con- 
tinued, however, regularly at his occupation, and his appetite was, for the 
most part, good. Dr. S. learned at this time also, that, on the 15th of July, 
one week previous to his visit, he had felt more unwell than usual ; yet he 
could give no definite idea of his sensations, excepting that he was weak, and 
unable for his work. Of his own accord, he brought a pail of sea-water to 
his house, in the afternoon of the above-named clay, and bathed himself by 
sponging his whole body with it, in his chamber. Shortly after this bathing, 
he was seized with violent rigors, which continued for some time, and he was 
forced to take his bed, in order to get warm. Soon after this, a diarrhcea 
commenced, and continued through the night, the discharges being quite 
frequent, but unattended by pain. 

On Friday (16th), he felt better, and from this time until the following 
Thursday (22d), he attended to his business, with some interruptions, and 
considerable inconvenience. At his visit on this day, Dr. S. found him 
dressed, and sitting in his parlour, and he appeared as well as he ever saw 
him ; there was no indication of any serious disease ; the pulse was undis- 
turbed; the tongue natural ; bowels regular; skin in healthy condition ; no 
pain or sense of soreness anywhere ; appetite, however, was wanting, although 
food was not offensive. Dr. S. advised some vegetable bitter, and rest from 
labour; and, if the patient felt able, a few days' residence in the country. 

Dr. Salter was summoned to the patient again on Monday, 26th of July, 
and was told that he had been to Billerica, on the 23d (Friday). The journey 
benefited him apparently; he passed a good night, and his sleep was refresh- 
ing; on Saturday morning, he reported himself better than for sometime 
previously. About noon, he was suddenly seized with intense pain in the 
lower part of the abdomen ; a physician was called, whose remedies relieved 
the pain after an hour's suffering. Being anxious to reach home, he returned 
to Boston the same afternoon. On Monday (26th), Dr. S. found him in bed; 
he was feverish; the pulse 100 per minute, and slightly irritable; the tongue 
covered with a thin white coat; no headache; but occasionally slight pain in 
the lower part of the abdomen. On examining that region, some fulness and 
distension were remarked, but there was no tenderness upon any degree of 
pressure ; there were frequent eructations of wind, with occasional hiccough. 
No change whatever took place in these symptoms, except gradual aggravation 
of them, until Thursday, the 29th July (one week from his first call on Dr. 
Salter) ; at this date, at the morning visit, the abdomen was very tympanitic, 
and other symptoms indicated rapidly approaching dissolution ; still, he was 
frequently up, walking about the room, sitting upon the sofa, and, by his own 
account, feeling quite comfortable, experiencing no pain, and no material in- 
convenience from the distension of the abdomen ; he continued thus until 
three o'clock, P. M., when, becoming faint (he was sitting up at the time), 
he was laid upon the bed ; immediately after, in addition to the belching of 
wind, he was almost constantly throwing up the liquid contents of the sto- 
mach, especially after drinking, which, from great thirst, often occurred. 
This state of things, together with hiccough, continued, with scarcely any 
interruption, until within a few minutes of his death, which took place at 
about six o'clock the same afternoon. After his return from Billerica, no 



76 Morland, Extracts from Soc. for Med. Improvement. [Jan. 

attempt was made at anything farther than a bare palliation of existing 
symptoms, which was accomplished with tolerable success, by injections, 
fomentations, and anodynes, when necessary. 

On post-mortem examination, sixteen hours from patient's decease, made 
and reported by Dr. F. S. Ainsworth, the following appearances were re- 
corded : — 

A large quantity of frothy fluid ran from the mouth and nose on slight 
movement of the body, or on pressure made over the stomach ; the fluid 
stained the cloths about the head a dark brown colour. The limbs were 
moderately stiff. 

On opening the abdomen, the stomach and intestines were found to be 
distended by gas; several ounces of dark coloured bloody serum were found 
in the peritoneal cavity ; the stomach and liver were natural in appearance 
and consistence ; their peritoneal coats showed no signs of inflammation ; on 
tracing the small intestines downwards into the lower part of the abdomen, 
and into the pelvis, they were found very red and inflamed; the peritoneal coats 
were adherent to each other by the effusion of coagulable lymph, flakes of 
which were found diffused in this portion of the peritoneal cavity, and of 
great thickness — on the intestines especially. The ascending, transverse, and 
descending colon appeared healthy ; all signs of peritonitis seeming to be 
confined to the pelvic region. On opening the small intestines, the jejunum 
looked healthy, and also the ileum in its upper part, and until within two 
feet of the ileo-caecal valve, where deep and extensive ulcerations of Peyer's 
patches were discovered, apparently of long standing; some of these were 
nearly cicatrized; others were in the process of healing; in several of them 
the destructive process had extended through the mucous and muscular, to 
the peritoneal, coat ; and, in one spot, the ulceration had perforated all the 
coats of the intestine, and had opened it into the peritoneal cavity. Over 
the ileum, where the deepest ulceration of the glands existed, and especially 
over the perforation, the serous tunic of the intestine was covered with a pro- 
fuse exudation of lymph, which closed the perforation and glued the folds of 
the intestine together. The mesenteric glands of the lower portion of the ileum 
were inflamed, and, in one or more instances, suppurated. 

The right lung was bound to the pleura costalis by strong and firm adhe- , 
sions throughout its whole extent, but crepitated well; the left lung was 
larger than usual and apparently healthy; no tubercles found in either lung. 
The heart was small, flabby, and much loaded with fat; the mitral valves 
were thickened along their edges, and the semilunar valves of the aorta were 
considerably ossified; the pericardium contained more than the usual quan- 
tity of fluid. Other organs not examined. 

Dr. J. B. S. Jackson said he was inclined to consider the case reported by 
Dr. Salter as one of mild or latent typhoid fever; the disease not fully de- 
clared by the symptoms ; the ulcerations were of an ashen-gray hue, and, 
moreover, the patient is stated to have been unwell since last April. Dr. J. 
referred to a patient attended by Dr. Strong, and who was complaining for 
four months : post-mortem examination showed both old and recent ulcera- 
tions of the intestines. In Dr. Salter's case, the same appearances are noted. 
Dr. J. thinks these cases not infrequent, and that a patient thus affected 
always demands the most careful watching. 

Dr. Parkman asked if it be not true that perforation occurs most fre- 
quently iu the so-termed " mild" cases? 

Dr. Jackson believed this to be the case. 

Dr. Gould asked whether it is usual for a patient to live so long after the 



1853.] Morland, Extracts from Soc. for Med. Improvement. 



77 



occurrence of perforation as did Dr. Salter's ? Dr. Gr. had met with several 
cases, and had never known the patients to survive longer than twenty-four 
hours. 

Dr. Jackson considered the prolongation of life due, in the case in ques- 
tion, to the occlusion of the perforation and the "gluing down" of the intes- 
tine by the lymph ; the peritonitis was thus circumscribed. 

Dr. Minot mentioned a case somewhat similar to the above. A man who 
had for some time been slightly unwell, was advised by his physician to ab- 
stain from labour and remain quietly at home; refusing to do this, he was 
attacked not long after (a few days), very suddenly, by violent abdominal 
pain, supposed to be that of colic. Dr. Minot was called to him at this time, 
and inferred the occurrence of intestinal perforation. The case terminated 
fatally in thirty-six hours. No post-mortem examination obtained. 

[Dr. Minot has informed the Secretary, since the record was made up, that 
Dr. Chaplin, of Cambridgeport, who attended this patient before he came to 
the city, pronounced him then to be convalescent from typhoid fever; a few 
days only before he was seen, as above, by Dr. MJ 

Wound of the internal Iliac Artery, caused by Instruments used with intent 
to expedite Labour. — Dr. Hayward, Sen., had seen, in a late number of 
the London Times, a report of a judicial action against a person accused of 
causing death by the manipulations above mentioned. 

In conjunction with this, Dr. H. referred to another case of the kind, which, 
singularly enough, he had heard an account of while in New Bedford, where 
it occurred, upon the same day on which he had read the report of the Times. 
A married lady, thirty-five years old, and six months advanced in pregnancy, 
went to the office of a homoeopathic practitioner, who, it is supposed, at her 
request, attempted to procure abortion, instrumentally ; the membranes, how- 
ever, as it subsequently appeared, were not ruptured j death followed ; the 
operator is arrested and held for trial. 

The following are the post-mortem appearances, communicated to the So- 
ciety by Dr. J. B. S. Jackson, who received them from Dr. Lyman Bart- 
lett, of New Bedford : — 

External Appearance of the Body. — Surface very pale, otherwise normal; 
in left hypochondriac region an apparently recent contusion, near the superior 
spinous process of the ilium, in size about that of a nine-penny piece — yellow 
and hard; eleven other similar, but smaller spots below this, upon the abdo- 
men and upper part of the left thigh ; slight superficial ecchymosis, as from 
a contusion, about the posterior commissure of the labia externa; similar spots 
upon the nates, each side of the anus; evident ecchymotic contusion over the 
posterior portion of the labia externa ; abdomen considerably distended. 

Dissection. — Upon opening the abdomen, about two quarts of bloody serum 
escaped ; the intestines were seen to be covered by an apron of coagulated 
blood, about six inches in vertical, and ten inches in transverse diameter, and 
of an average thickness of two inches ; on removal of this coagulum, the in- 
testines were seen, pale ; the folds of the mesentery, attached to the lower 
portion of the small intestines, are separated by a clot of blood which would 
fill a pint bowl ; the inferior fold of the mesentery was ruptured by the pressure 
of the blood accumulated between the folds. The uterus was flaccid, and in 
volume about the size of a three-pint bowl; on its posterior surface, opposite 
to the promontory of the sacrum, was observed an opening through its pa- 
rietes, made, apparently, by some cutting instrument, whose diameter would 
be that of a pipe-stem, or of the common catheter; corresponding to this 
No. XLIX.— Jan. 1853. 6 



78 Morland, Extracts from Soc. for Med. Improvement. [Jan. 



opening, another of the same size and appearance existed, going through the 
peritoneum forming the inferior fold of the mesentery. Beneath this punc- 
ture in the mesentery, and corresponding to it, was found an opening into the 
right internal iliac artery, one-fourth of an inch below the bifurcation of the 
main iliac artery, and of sufficient size to admit the point of a goosequill. On 
opening the uterus, a small foetus was found, measuring seven and a half 
inches from the vertex capitis to the nates; its finger-nails perceptible. The 
membranes were not ruptured; on the posterior internal surface of the uterus, 
one and three-fourths inches above its cervix, was a puncture, extending 
obliquely two inches in length, through the parietes of the organ and termi- 
nating at the puncture previously mentioned, so that a blunt-pointed probe 
passed readily through from one orifice to the other. About half an inch 
from this puncture was found another, made obliquely into, but not going 
through, the uterine walls; its course parallel to the former; its length one 
and a half inches. Contusion, with ecchyinosis, observed upon the internal 
surface of the posterior portion of the uterus. 

All of these punctures corresponded with the mouth of the uterus, so that 
an instrument passed into the vagina would go in the direction, and produce 
the wounds, above described. 

Death followed these manipulations in about twelve hours. 

Present at the post-mortem examination, Drs. Spooner, A. and J. Mackie, 
Fulsome, and Lyman Bartlett. 

August 9. — Imperfect Physical and Mental Development — Dr. Townsend, 
Sen., exhibited to the Society a girl four years of age, who cannot walk or 
speak ; all the other bodily functions are healthily performed ; at birth, which 
was natural, she was supposed healthy and perfect; she notices objects some- 
what, but the amount of intelligence is certainly small; she is mechanically 
supported into a sitting posture, not having the power of holding herself up- 
right. Her appearance is rather prepossessing, with an absence of any idiotic 
expression. 

Dr. Gould reported a case in which, after severe and protracted labour, 
the child was stillborn. It was placed in a tub of warm water, and artificial 
respiration employed for about an hour, and, finally, breathing was established. 
She is now nearly fifteen years of age, and has always been healthy. In in- 
fancy, spasms and rigidity of the neck and limbs were noticed ; contortions 
of the face and thrusting out of the tongue succeeded, so that she has an 
idiotic look. She has learned to talk, but articulation is difficult. She has 
never been able to control the limbs so as to be able to support herself; so 
that it is necessary to carry her about, and to feed her. She began to men- 
struate at thirteen, and has menstruated rather profusely. It was hoped that 
some favourable change might take place at this period ; instead of which the 
contractions have become much more general and severe ; and for a few weeks 
past, her sufferings have been intense, both day and night. The right arm is 
rigidly and constantly extended, and the fist clenched, and both the arms are 
so contorted that the elbows, much of the time, present in front; the right 
thigh and leg are flexed to the utmost, and also are drawn forcibly against or 
across the opposite limb, which is usually fully extended. For many nights 
in succession she has been unable to sleep beyond five minutes at a time. 
The recumbent posture always aggravates the spasms; and sometimes it is 
very difficult to retain her in an arm-chair. Opiates and antispasmodics of 
all kinds and in large quantities have been almost ineffectually employed. 



1853.] Morland, Extracts from Soc. for Med. Improvement. 



79 



Indian hemp at one time seemed beneficial. Chloroform has been taken very 
frequently, and soon relieves her, but its use is attended with nausea and 
vomiting to such a degree as, in a great measure, to preclude its employment. 
The intellect is unclouded, and the moral sense is unusually strong. She 
enjoys reading, and converses well. 

In view of the unfortunate condition which has been observed so often to 
follow in similar cases, Dr. Gr. considers the expediency of long-continued 
efforts at resuscitation as quite questionable; especially in cases where the 
severity of the labour has been such that injury to the cranial contents might 
reasonably be apprehended. In asphyxia from causes not involving such in- 
jury, a different course might not be attended with the same objections. 

Dr. Jackson remembered hearing the same sort of cases mentioned by 
Dr. Bigelow, Sen. Dr. J. also said he had previously reported one or two 
cases to the Society, in which resuscitation was very difficult ; in one of these 
instances, the child did not fairly breathe for three-quarters of an hour ; both 
children lived to grow up, well. 

Dr. Storer thought it pretty well established that children born under 
such circumstances are, if they recover at all, weak, puny, and short-lived. 

[At the next subsequent meeting of the Society, Dr. Alley related a case 
analogous to that reported by Dr. Gould. The child presented the breech, 
and, when born, was quite black; by great exertion it was made to respire; 
now, at twenty-one years of age, the control possessed by this individual over 
the muscles is but partial. The mother once previously had a child bom 
with the breech presenting; it was stillborn and not resuscitated.] 

Dislocation of the Hip; Easy Manual Reduction under the Influence of 
Ether. — Dr. Parkman reduced a recent dislocation of the hip very easily 
with his hands alone, and unassisted, the patient being thoroughly etherized. 
The head of the bone was in the ischiatic notch: taking the foot in his 
hand, Dr. P. bent the leg on the thigh, and the thigh on the abdomen, 
and, with slight outward rotation of the foot, drew the limb downwards, 
with immediate reduction of the displaced bone. The dislocation was caused 
by the fall of some bags of coffee upon the patient, who was aiding in raising 
them from a vessel's hold. 

Disease of the Cerebellum and of the Arteries at the Base of the Cerebrum. — 
Dr. Minot reported the case. The patient was a female, aged sixty-eight, 
who had met with much care and hardship. She had borne several chil- 
dren. Within a few months she had suffered from vertigo, and there was 
loss of memory; the intellect was not impaired. 

July 28. The patient walked out and became fatigued ; next morning she 
rose as usual, but immediately fell to the floor, nearly insensible ; she soon 
became stupid, although she was capable of being roused, and would then 
answer with tolerable accuracy and intelligence. Articulation was indistinct; 
respiration puffing, as in smoking; pulse 100, not feeble; pupils natural; 
urine passed involuntarily; the mouth was drawn to the right side; the 
left eyelid drooped. There was no paralysis of the limbs ; she would not, or 
could not, protrude the tongue. 

She was freely purged, and sinapisms were applied to the extremities. 

The next day her condition was about the same ; the dejections involun- 
tary ; six leeches were applied to the left temple. Towards evening her face 
became of a dusky-red hue, her skin burning hot; pulse at 100; articula- 



80 



Morland, Extracts from Soc. for Med. Improvement. [Jan. 



tion unintelligible, and there was great drowsiness, from which she could with 
difficulty be roused- six leeches to the right temple, which bled very freely. 

On the third day the skin was natural, the face pale, the pulse 100, weak 
and intermittent ; the intelligence good, the replies to questions prompt and 
correct; the tongue was readily protruded for the first time, and the facial 
paralysis had considerably diminished; stimulants were ordered. 

In the afternoon the drowsiness returned, with the puffing respiration pre- 
viously mentioned; the skin was of a dark colour; insensibility speedily came 
on, continuing for thirty-six hours, when she died. 

Post-mortem examination disclosed an excavation on the inferior surface of 
the cerebellum, having the appearance of an ulceration ; it was uniform and 
lined with a false membrane; its extent, one and one-half inches in length, 
by one inch in breadth, and of capacity sufficient to contain a bean ; the pia 
mater could be inflated over it ; the arteries at the base of the brain were 
found extensively filled with atheromatous deposit. No ramollissement ; the 
scalp was gorged with blood; the dura mater was adherent to the brain, and 
could not be separated from it without tearing the substance of the latter 
at one spot, at the left side of the anterior third of the longitudinal fissure ; 
there were traces of old lymph deposit at this place. 

Dr. Minot showed the specimen to the Society, and remarked, in addition, 
that Andral, in his researches, states that he had seen only sixteen cases of 
lesion of the cerebellum. 

August 23. — Melanosis of the Eyeball. Reported by Dr. Bethune. — . 
Mrs. B., set. 62, first seen August 17. Health generally good. She never 
had disease of the eyes till one year ago ; was first attacked with commencing 
loss of sight of the left eye, without pain or soreness. The sight continued 
to fail, and, in December last, the eye began to be painful occasionally, and 
the ball to enlarge and grow dark. These symptoms have continued from 
that time. Since the eye has troubled her, the appetite has failed, and sleep 
has occasionally been disturbed. Now, the right eye is well. Left eye, the 
anterior third of the ball is enlarged, and protrudes between the lids — is of a 
black colour, and presents a generally smooth, shining surface ; at the superior 
part (where the discoloration commences) it is covered with" large, dilated 
vessels. Lids apparently not affected. • , 

20t7i. Operation. — This presented nothing unusual, except that the globe 
was found so soft, anteriorly, that the ligature, used to bring the eye forward, 
tore through. 

SI st. Discharged well. 

On examination of the eye after removal, it presented the following ap- 
pearances, described by Dr. J. B. S. Jackson : " The melanotic mass pro- 
truded from the front of the eye, prominent, defined, and equal to about half 
an inch in diameter, though of an oblong form. A section having been made 
through the globe of the eye, the diseased mass was seen very nearly to fill 
the anterior chamber, but could not be distinctly traced posteriorly to the iris. 
Lens of a pale brownish colour, and very soft. The vitreous humour was also 
quite liquid, and somewhat discoloured. The tunics of the eye generally 
seemed healthy. The cornea was most distinctly traceable throughout the 
melanotic mass, upon the cut section being somewhat opaque, but not at all 
thickened." 

Dr. Bethune added that the progress of disease in this case was wholly con- 
trary to his previous experience of melanosis of the eyeball. In the cases 
with which he had previously met (from tun to twenty), and several of which 



1853.] Morland, Extracts from Soc. for Med. Improvement. 



81 



he had published, the disease, as far as he can recollect, has apparently com- 
menced in the posterior portion of the eye, and has thence advanced to the 
anterior. The reverse, as will be observed, was the case in this instance. 

Want of Synchronism in the Ventricular Pulsations. — Dr. Gould had ob- 
served an instance of this, occurring without discoverable organic disease, and 
also without functional disturbance of the heart. The three sounds attending 
the systole of the auricle and of the two ventricles, were distinct. 

Purpura Hemorrhagica. — Dr. Storer related the case. Miss I — , a 

nurse at the Massachusetts General Hospital, who had been quite feeble for 
several weeks previously, was compelled to relinquish her duties early in July, 
and submit to treatment. Dr. S. found her extremely languid, with a sallow 
countenance, dry skin, and very feeble pulse ; the gums were spongy, and the 
whole lining membrane of the mouth and throat was parched, and of an 
unhealthy, dusky hue; the breath was exceedingly offensive. She daily 
became more prostrated, complained of stiffness and soreness in her limbs, 
and, finally, inability to sit up in bed, for a moment even, without faintness. 
In about three weeks after her first confinement to her chamber, she died, at 
the residence of her mother, where she had been carried for the sake of a 
purer atmosphere. At her death, a hemorrhage took place from her mouth. 
Although Dr. S. had never been able to observe any spots of purpura, he 
considered this a case of that affection. 

Dr. Durkee remarked, that while visiting the hospital, a few days before 
the patient referred to came under medical treatment, she spoke to him of an 
eruption on her lower extremities; he examined the spots, and they proved to 
be petechial. 

Dr. Storer observed that this fact settled the correctness of his diagnosis. 
He had been able to detect no such marks on the upper extremities, and was 
told by the patient none existed on any portion of her body. This patient 
was an invaluable nurse in the Institution to which she was attached ; un- 
wearied in the discharge of her duties — not willing ever to be thought unfit for 
work — and it is to this alone can be attributed her disinclination to conceal 
any of her symptoms. 

September 13. — Pus within the Shaft of the Tibia — Trephining of the 
Bone — - Cure of the Diseased Limb.— -Dr. Strong reported the case. A. Y., 
forty-two years of age, a shoemaker in winter and a farmer in summer, was 
attacked twenty-eight years ago, at the age of fourteen years, by a fever, de- 
pendent probably upon acute necrosis, a disease not uncommon in the northern 
parts of New England. Dr. S., when a pupil of Dr. Nathan Smith, observed 
many cases of it, and he believes that Dr. Smith, who resided many years in 
Hanover, N. H., was the first to describe the affection, and to discover the 
best remedy for it. The disease consists essentially, as it would seem, in 
inflammation of the periosteum, and of the lining membrane of the medullary 
cavity, and is attended by sympathetic fever • the severity of the latter being 
proportionate, ordinarily, to the extent of the local disease ; matter next forms 
between the periosteum and the bone, and also within the medullary cavity. 
When left to itself, or only opened through the periosteum, a portion of bone, 
usually equal to the space occupied by the matter, dies j it is sometimes sepa- 
rated and thrown off, but more frequently is surrounded by new bone, through 
which openings exist and continue to discharge pus until the bone is broken 
up and taken away. Dr. Smith, in the acute cases, was in the habit of cutting 



82 



Morland, Extracts from Soc. for Med. Improvement. [Jan. 



at once down to the bone, as soon as any matter was discovered ; making the 
incision longitudinally, in the direction of the bone, and for an extent com- 
mensurate with the portion denuded of its periosteum. The next step in the 
operation was to open into the medullary cavity, either with a trephine or 
with a perforator made for the purpose ; the openings to be made in one or 
more places, according to the extent of the denuded bone. Dr. Strong said 
he had often seen this operation done, and in no instance where matter did 
not issue from the medullary cavity, pouring out with each arterial pulsation. 
If the operation was performed at an early period of the disease, necrosis of 
the bone was prevented, and the patient was at once relieved \ recovery being 
rapid. 

In the case about to be reported, Dr. S. diagnosticated the existence of 
pus within the bone. The inflammation occupied the upper third of the tibia. 
The integuments had been once opened without perforating the bone, some- 
time previously, and pus had been discharged for more than four years, when 
the opening healed Ever since that time the limb has been troublesome, 
especially in dull, easterly weather. Two years ago last midsummer, the 
patient injured his limb by jumping from a load of hay, since which accident 
it has gradually, but continuously, grown worse. Patient, however, kept 
about upon it until last February, when he took his bed, and was confined to 
it , for the most part, his ability to leave it growing less and less, until the 
time when Dr. Strong first saw him, some five weeks ago; he could then only 
with great difficulty be removed from it. Not long after the above-named 
accident, he began to complain of a burning or scalding in the site of the old 
injury, accompanied by a throbbing sensation. About the same time, violent 
neuralgic pains attacked him, worse at night, and affecting nearly the entire 
body, accompanied by spasmodic action ; during the paroxysms, the patient 
said he saw " balls of fire" accompanying the darting pains. The tongue was 
clean, very red, and rather dry, at times slightly coated about the edges; he 
was sleepless ; without appetite ; emaciated rapidly. Dr. S. saw him first on 
the 2 1st of August. All his symptoms were then at their height. The system 
was in a highly irritable condition ; he was depressed in spirits ; his pulse 
frequent; nothing afforded him any relief. He had changed his medical ad- 
visers several times, without benefit, and had now returned to his original 
physician, Dr. Amos Batchelder, of Pelham, N. H., a very excellent prac- 
titioner. Several surgeons had seen the patient in consultation, and all, with 
the exception of Dr. Batchelder, had condemned his limb to amputation. 
The left leg was very much contracted on the thigh, and was immovable ; 
there was fluid in the synovial cavity of the knee-joint; the tibia was enlarged 
throughout the whole of its upper third, to about three times its ordinary 
diameter; the disease occupying the whole cancellated structure of the head 
of the bone, and extending into its shaft; the skin was smooth, with but little 
if any redness. On the inner side of the tibia, not far from the longitudinal 
centre of the enlarged bone, was an old cicatrix over the spot where the open- 
ing had formerly been ; there was but little tenderness over this spot; the 
pain was not confined to any one part, but extended throughout the whole 
leg. The medicinal applications, although sometimes covering the whole 
limb, were for the most part confined to the enlarged portion of the tibia. 
In consultation with the patient's attending physician, Dr. S. confidently ex- 
pressed the opinion that pus was contained within the bone, and that probably 
dead bone was also inclosed within the enlarged portion of the tibia, and that 
by trephining the bone, and getting rid of the offending contents, life and 
limb might be saved. Without this operation, the patient would lose one or 



1853.] Morland, Extracts from Soc. for Med. Improvement. 



S3 



the other, and perhaps both, as his system was fast being undermined. 
After this, the patient delayed for three weeks, consulting, in the mean time, 
several physicians and surgeons ; was not relieved, and was advised to submit 
to amputation as the only effectual remedy. He now, however, decided to 
undergo the operation proposed by Dr. Strong, which consisted in making a 
longitudinal incision, beginning about one inch below the knee-joint, and car- 
ried through the old cicatrix, and farther down, about five inches in all, pene- 
trating throughout to the bone. The periosteum was then peeled off from 
the bone, but with the greatest difficulty, owing to its excessive thickening, the 
thickness being from a quarter to a half inch, and the whole tissue very adhe- 
rent to the bone. Spicula of bone extended into the diseased periosteal mem- 
brane; the bone was very rough. Next, a trephine, one inch in diameter, was 
applied over the old opening, and was carried down, by chipping off the sawed 
fragments, until it was wholly buried in the bone, and the medullary cavity 
not then reached, after going so deep. Being embarrassed by it, the trephine 
was removed, and a common perforator substituted, which, in a short time, 
plunged into a cavity, when pus immediately and freely issued, to the amount 
of from three to six ounces ; its exit was not made at one rush, as from an 
opened abscess in the soft tissues, but gradually, and with the ventricular 
pulsations of the heart, until the quantity just mentioned had flowed from the 
aperture, before the wound was dressed. This discharge has continued freely, 
in greater or less quantity, to the present time ; and, for the first few days, 
from four to eight ounces passed away daily. The opening was made partly 
into the cancellated structure ; the bone was very vascular, bled freely, and 
was comparatively soft; the state of inflammation very marked. The opera- 
tion gave immediate relief, all the old symptoms disappeared, and the patient 
has been rapidly recovering ever since ; his general health improving with the 
banishment of the local disease. 

October 6. Patient is able to ride out and visit his neighbours. Six or 
eight pieces of dead bone, varying in size from one-eighth to one-quarter of an 
inch, have been discharged from the wound. The use of the knee-joint is 
gradually being regained ; the limb can be straightened voluntarily ; the cure 
must soon be complete. 

In default of ether at the time of operating, the patient was plied with 
tincture of opium and with spirit, until he was thoroughly intoxicated. He 
suffered no pain, and was not aware that the operation was being performed. 
The spirit was ejected from the stomach soon after the operation was com- 
pleted ; some irritation of the stomach followed, and the usual disagreeable 
sensations from taking a large dose of laudanum were experienced, but in less 
than twenty-four hours these had wholly passed away. 

Retention of the Appetite in Typhoid Fever. — Dr. Jackson mentioned an 
instance of this. He had never previously observed it in typhoid fever; in 
typhus it does, at times, occur. The case he alluded to was rapid in its pro- 
gress, and severe in its character. In the course of ten days, delirium, sub- 
sultus tendinum, involuntary discharges, and coma had all been observed. 
Thirteen days from the commencement of the disease, some intelligence was 
manifested. From the sixteenth to the twentieth day, improvement was 
evident. The bowels were costive throughout the disease; laxatives were 
required two or three times. Unequivocal rose-spots were observed. The 
chief point of interest is the persistence of appetite through the entire course 
of the disease. The patient asked for meat, sausages, and pudding. 



84 



Morland, Extracts from Soc. for Med. Improvement. [Jan. 



Foreign Body in the (Esophagus. — Dr. Coale was consulted for the re- 
moval of a cent from the throat of a child, who had swallowed it, partially, 
while lying on its back. The mother instantly suspended it by the heels, 
slapping its back, and also gave it mustard and water, with powerful emetic 
effect. No dislodgment of the coin was evident. Three or four days subse- 
quently, pain being complained of, Dr. C, on examination, found the cent 
still lodged, about four inches down the oesophagus. The probang did not 
force it downwards. Dr. S. D. Townsend saw the patient in consultation. 
On the tenth day, Dr. C. passed a probang, the head of which came off (having 
been carelessly joined to the handle), and descended to keep the cent com- 
pany ! Dr. G. afterwards removed the cent by forceps. The bowels, which 
were perfectly regular previously to the accident, became confined under the 
use of a mucilaginous diet ; there being only one discharge in three days. 

Dr. J. M. Warren inquired of Dr. Townsend, Sen. the result of certain 
similar cases treated by him at the hospital. Dr. T. said he had passed the 
probang successfully in these instances. He has not yet heard whether the 
coins have been passed from the bowels. 

Dr. Warren mentioned a case in which he had advised delay, without any 
medicinal or surgical intervention, until the day following the accident, when 
the probang was to be used, if required. Six weeks afterwards, the cent, 
which had been swallowed, came away from the bowels, not at all acted upon 
by their secretions. Dr. W. added that coins, when swallowed, generally pass 
from the bowels in three or four days. 

Dr. Coale referred to one case in which a cent came away in fifty-six hours. 

Cotyledon Umbilicus in Epilepsy. — Dr. S. L. Abbot mentioned an instance 
of the power of this remedy in arresting the attacks of epilepsy. He had 
administered it in the dose of five grains of the extract, night and morning, 
for eight months, with entire cessation of the fits during that period. The 
patient was a gentleman, upwards of fifty years old, who had been subject to 
the disorder for five or six years ; the epileptic fits occurring, at the time the 
use of the remedy was commenced, as often as once in two or three weeks, 
with one or more attacks of epileptic vertigo daily. The vertigo, under the 
use of the remedy, diminished in severity, but not in frequency. At the end 
of eight months, the patient began to totter very much in his gait, with fre- 
quent u dropping turns," as if from his legs "giving way" under him, with 
only partial loss of consciousness. No convulsion, but a slight general tremor, 
with some rigidity of the limbs. A feeble, unexcited pulse, and no flush 
or heat of countenance. At this time, the use of the cotyledon umbilicus 
was discontinued, and a small quantity of phosphoretted oil was given, which 
was followed on the third day by a bad epileptic fit, and its use was conse- 
quently abandoned. Since that time, the epileptic attacks have occurred at 
intervals of three or four weeks, and the other morbid phenomena are of daily 
occurrence. Under these the powers of life appear to be gradually failing. 

Dr. H. 0. Stone referred to two cases in which the cotyledon umbilicus 
had been used with good effect. In one case there was an interval of one 
hundred days between the fits, after using the medicine a short time. 

Dr. Ho mans asked if any other remedy had been used in .this case, and if 
strict regimen had been observed. Dr. H. said that it is nearly always true 
that epileptics are great eaters. Rigid diet has always seemed to him the 
most effectual means in combating the disease. He does not, by trial, find 
the nitrate of silver or any other medicine answer his former expectations. 

Dr. Abbot said that the patient was, so far as his strength permitted, 



1853.] Morland, Extracts from Soc. for Med. Improvement. 



85 



actively engaged in business, and extremely reluctant to curtail his allowance 
of food. He, however, abstained from fluid stimulants, and his diet was of 
the most simple character. Various remedies had been tried; e. g., infusion 
of digitalis, iron, &c. The former was used for six weeks, with gradual de- 
crease of the vertiginous attacks. Dr. A., however, feared to continue it 
longer. 

[Dr. Charles Bland Radcliffe, of London, in a recent and exceedingly 
well- written pamphlet, styled Comments on Convulsive Diseases, takes some- 
what new ground in regard to the management of epilepsy. He believes it 
to be always a disease of debility, not of excited condition of system. That 
plethora enters in nowise into its production or prolongation. That epileptic 
and epileptoid convulsions are connected with a state of body " the very op- 
posite of vascular activity/' That delicacy, not vigour, as the rule, charac- 
terizes individuals affected with diseases termed convulsive. Dr. B. adds 
that sufficient reason exists to cause us to doubt " that venous congestion in 
the head and neck (so marked in epilepsy) is essentially connected with con- 
vulsion." With these views of the nature of this disease, the writer advises 
a treatment almost exclusively tonic. Bloodletting is not to be thought of. 
Purgatives, except when demanded by evidently obstructed bowels, are inad- 
missible. Iron, quinine, turpentine, and nitric ether are recommended; and, 
in a very decided manner, the use of a generous diet is particularly enjoined — 
instances of its efficacy being adduced — and the employment of stiimdants, 
even, under proper regulations, is counselled. The author's position and 
arguments derive great support from physiological and pathological facts, of 
which more cognizance, in their relation to treatment, might advantageously 
be taken. Dr. Radcliffe's summary of treatment in epilepsy is, that "the 
essential indications require rest, a nutritious and generous diet, with warm 
bathing, and the most sedulous avoidance "of all debilitating practices, and, 
in the more difficult cases, medicinal tonics and stimulants." 

The high authority of Dr. Marshall Hall, in his late work on Cerebral and 
Spinal Seizures, goes for a rigid system of mental discipline, of diet, &c. 
The acetate of strychnine, in its tonic dose, is favourably mentioned by Dr. 
H.; the one-fiftieth part of a grain thrice a day. — Secretary.] 

Fracture of the Ligament of the Patella treated without Bandages. — Dr. 
GrOULD reported this case. A man, in attempting to reach the railroad cars, 
while in motion, ruptured the ligament of the right patella by his efforts in 
running. This occurred in August of last year, and Dr. Gr., not wishing to 
confine him too closely in the hot weather, tied a silk handkerchief around 
the foot, and had its lung up to the bedpost, thereby keeping the limb fully 
extended. No bandages were applied, except one above the patella for a 
short time. In six weeks, the man walked well, and in another week he was 
able to go to his occupation. He was an intelligent and manageable patient, 
who could be trusted to aid in the carrying out of such treatment. 

Excision of a Portion of the Inferior Maxillary Nerve for the Relief of 
Neuralgic Pain. — Dr. Parkman excised a piece of the inferior maxillary 
nerve, about three weeks ago, at the hospital. The patient was a woman, 
forty years old, who had suffered neuralgia of the entire face for from twelve 
to thirteen years. The point of departure for the pain was from the right 
side of the lower lip. About one-eighth of an inch of the nerve was removed, 
with immediate and complete relief of the pain. Paralysis of sensation fol- 



86 Morland, Extracts from Soc. for Med. Improvement. [Jan. 

lowed the operation, and is nearly total over the right side of the lower lip. 
Slight sensation only is found when the part is pricked with a needle. 

Cases of Occlusion of the Vagina. Dr. J. Mason Warren. — Occlusion 
after Labour. — Mrs. M., thirty-five years old, applied to Dr. W. about'a year 
since, with the following statement from her physician: "Mrs. M., some 
years since, immediately after giving birth to her first infant, was attacked 
with pleuritic inflammation, which resulted in hydrothorax. Her strength 
became greatly impaired, and oedema of the cellular membrane was quite 
general. While labouring under this low state of her general health, it was 
discovered that the mucous membrane of the vagina had begun to slough. 
Summoned to see her, I found this so much the case that the separation of the 
slough was easily effected with the forceps, and I was able to remove it readily 
by the scissors. The process of casting off the slough having been completed, 
a copious discharge of thin ill-conditioned pus flowed away, acrid enough to 
excoriate the labia and surrounding parts. Suitable bougies were provided 
and introduced, to prevent the contraction and adhesion of the surfaces of the 
vagina; but, so great was the sensitiveness of the parts, that, though warned of 
the consequences in neglecting their use, they were imperfectly used, or alto- 
gether dropped, so that the occlusion became almost complete. A devious and 
extremely small canal was found to exist, by which the catamenia have flowed 
away. In the efforts made to explore it, a very small probe was made to 
pass a short distance along the canal. No prolonged effort at dilatation has 
ever been attempted in her case, nor has she for years been subjected to medi- 
cal examination. 

u I should have remarked that the labour in giving birth to her infant was 
a very rapid one, and that the child was so small and delicate that it lived 
but a short time. The labour was conducted by a careful midwife, no physi- 
cian being near, and no ground existed for believing that any injury whatever 
was sustained by the vagina in the passage of the child. Nothing unusual 
transpired to call the attention of her husband or attendants to the organs of 
generation. In the bad state of her constitution, under the dropsical tendency 
of her system, the irritation of the vagina, consequent on delivery, passed 
rapidly into a gangrenous state of the lining membrane. " 

Dr. Wi said that he found the vagina, as above stated, almost completely 
occluded. On one side was a small, tortuous passage, into which a probe 
penetrated for a short distance, and could be felt for the space of an inch or 
more through the parietes of the vagina, by means of a finger introduced into 
the rectum. With this guide, and with a finger kept constantly in the intes- 
tine, a careful dissection was made in the direction of the uterus. Yery 
shortly, all assistance from the fistulous passage was lost, and it was necessary 
to proceed without any guide. This was done with great caution, from fear 
of penetrating at the side of the uterus into the peritoneal cavity. In the 
course of two weeks, after a number of dissections, and the constant applica- 
tion of the prepared sponge, cut into a conical shape, and introduced so as to 
assist in dilatation, what appeared to be the os uteri was finally reached. 

At this period the patient had occasion to leave town. Dr. W. saw her 
again at the end of a month. The use of the sponge tent had been persisted 
in, and, by a slight cutting operation, the vagina was restored to nearly its 
natural dimensions. Previous to her leaving town, the catamenial discharge 
came on freely, and with less suffering than for many years. She was advised 
to persevere in the means which had been used to prevent the contraction of 
the vagina. 



1853.] Morland, Extracts from Soc. for Med. Improvement. 87 



Congenital Occlusion of the Vagina. — Miss P., fourteen years old, began 
to suffer, two years since, with pains in the lower part of the back and abdo- 
men. These pains gradually assumed a periodical character, coming on at an 
interval of four weeks, and were so intense as to require alleviation by means 
of medicine. 

A physician being consulted, suspected an obstruction of the vagina, and 
an examination confirmed his suspicions, showing this passage to be com- 
pletely occluded. An incision was made through the solid obstruction which 
presented at that part, with the hopes of discovering a cavity containing the 
menstrual fluid; but the operation met with no success. From this time, the 
sufferings of the patient gradually increased, and at the menstrual periods, were 
so severe as to produce a degree of prostration which confined her for some 
days to her bed, and finally even threatened life. 

When first seen by Dr. W., the external organs of generation were so sen- 
sitive as to cause great complaint from the patient on any attempt at an ex- 
amination. The external labia were found to be well developed. The orifice 
of the urethra occupied its normal position, or was a little lower than natural. 
Below this, not the slightest depression indicated the orifice of the vagina. 
The finger, being introduced into the rectum, detected, at the distance of 
about two inches from the anus, a hard, globular tumour, the size of a billiard- 
ball. Before removing the finger from the rectum, a catheter was passed into 
the bladder, and this was at once felt by the finger in the rectum, in the 
median line, the coats of the bladder and rectum only intervening, for a dis- 
tance of one or two inches — that is, as far as the above-mentioned tumour. 
At this point, the catheter could be made to pass on each side of the tumour, 
but was with difficulty detected in the rectum. Dr. W. had no doubt, from 
the result of the examination, that the tumour felt in the rectum was the 
upper part of the vagina and uterus distended by fluid, and the cause of the 
serious symptoms under which the patient laboured. An operation was there- 
fore proposed, and at once, with the assistance of her physician, performed. 
Anaesthesia being induced, a transverse incision was made directly below the 
orifice of the urethra. With much caution, a dissection was now made be- 
tween the rectum and the bladder, until, by cutting and separating the tissues 
by the fingers, the tumour described as felt in the rectum was reached, lying 
very deep, and affording but little opportunity for a fair examination. The 
depth at which it lay, and its apparent solidity, for a moment caused some 
embarrassment as to the proper course to be pursued, especially as one of the 
gentlemen present seemed convinced, from its hardness, that it could not con- 
tain a fluid. But, finally, Dr. W., being satisfied in his own mind that the 
tumour could be nothing else but what had been suspected, determined on 
puncturing it. The escape of the thick tarry fluid, which has been observed 
in one or two other cases before related to the Society, at once confirmed the 
truth of the diagnosis. The aperture was now enlarged so as to allow two 
fingers to pass freely up into the cavity containing the fluid, which was ap- 
parently the uterus and upper part of the vagina distended so as to form a 
single sac. 

The patient, on recovering from the effects of etherization, declared herself 
entirely relieved from her previous state of suffering. The use of the pre- 
pared sponge, to prevent the closure of the passage, was advised, as also the 
occasional introduction of bougies, to maintain, if possible, the normal size 
of the canal. 

Occlusion of the Vagina occurring soon after Marriage. — The patient was 
a widow, forty-five years of age. The account she gave was ; that she was married 



88 



Morland, Extracts from Soc. for Med. Improvement. [Jan. 



at an early age; that les premieres approches du mari were so violent as to cause 
a severe inflammation of the vagina, which eventually terminated in the almost 
complete closure of the upper part of the canal. At the catamenial periods, 
much difficulty and suffering were experienced in the egress of the menstrual 
fluid, which was discharged slowly, and apparently by a circuitous route. 
She suffered from this cause until within three years, when that function 
ceased to be performed, but was replaced by a mucous secretion. Her health 
latterly has been poor, and she has been more or less troubled with pains in 
the back and loins, all of which she has attributed to the retention of fluids 
in the uterus. 

On examination, Dr. W. detected an obstruction two inches from the orifice 
of the vagina, caused, apparently, by an adhesion of its parietes. With the 
aid of the speculum, a small aperture was observed on one side, into which a 
probe penetrated a short distance. 

As the patient insisted on having an operation performed, Dr. W. consented 
to do it, although, at the same time, he informed her that it was very doubt- 
ful whether the obstruction was the cause of the symptoms, considering the 
present state of the functions of the uterus. - 

A director was forced into the passage, which had at first only admitted 
a probe. This was followed by a larger instrument; and, by proceeding 
gradually, it was shortly found possible to use the dressing forceps. By 
this means, the passage was finally enlarged so as to admit the little finger, 
when, by tearing and distending the parts, almost the full size of the original 
passage was restored, and the extremity of the os uteri exposed, although buried 
in the adjacent structures. 

The caliber of the canal was maintained by the same means as had been 
resorted to in the preceding cases. The patient expressed herself much re- 
lieved by the operation, and, when seen a month afterwards, there had been 
no recurrence of the previous bad symptoms under which she had suffered. 

Abortion without a\ suspicion on the part of the Mother of the existence of 
Pregnancy. — Case reported by Dr. Storer, — August 28. At 1 o'clock, this 
morning, Mrs. S., of Charlestown, was awakened by hemorrhage from the 
vagina. She was married the latter part of December last, but her catamenia 
have appeared regularly; she has never experienced the slightest nausea; her 
appetite has not been impaired ; there has been no derangement whatever of 
the alimentary canal, nor perceptible enlargement of the abdomen. 

Not having the slightest idea of her being pregnant, she was not a little 
alarmed, and aroused her husband, who at once called up her mother, with 
whom she resided. The mother had never thought her daughter pregnant, 
although constantly with her, and, at first, could not imagine the cause of 
the hemorrhage. But when pains supervened, and assumed a degree of re- 
gularity in their recurrence, she felt satisfied that her daughter was in labour, 
and Dr. S. was sent for. In an hour or two after the commencement of the 
pains, the foetus was expelled. It measured nine inches in length, and the 
umbilicus was half an inch from the centre of the body. Dr. S. supposed 
the mother to have been between four and five months pregnant — nearly five. 
Upon examining patient's breasts, they were found to be large, but she did 
not perceive any unusual fulness. The areolae, however, exhibited those 
changes always so reliable ; their colour was much deeper ; their feel, velvety ; 
and the glandular follicles much enlarged; — thus pointing out, not merely the 
pregnancy, but also its advancement. 

In a medico-legal point of view, this case is interesting; inasmuch as, from 



1853.] Morland, Extracts from Soc. for Med. Improvement. 89 



the rational signs of pregnancy, a foetus may be carried even to the time 
most women quicken, without the" fact being suspected by the bearer, or any 
of her friends. 

Placenta Prsevia, with a Foot and the Funis presenting. — Dr. Storer re- 
ported the case. August 25, he visited, in consultation with Dr. Crane, of 
East Boston, a woman in labour. Thirty-one hours previously, having ad- 
vanced to the limit of her pregnancy, she was attacked with labour-pains, 
and about the same hour the membranes were ruptured. Dr. Crane saw her 
on the 24th inst. at 10 A. M., and, not finding his assistance required, he 
did not interfere. On the morning of the 25th, she commenced flowing; 
and, upon examining, per vaginam, Dr. C. found a portion of the placenta 
had been attached over the edge of the os uteri, but becoming separated, and 
the detachment extending somewhat beyond the os, hemorrhage had ensued. 
He also found the funis at the os uteri, and at its side, a foot. 

After carefully examining the case, Dr. S. advised an immediate delivery 
for the following reasons : Although, at the present time, there is no he- 
morrhage, yet as a partial detachment of the placenta exists, bleeding may 
occur at any moment; and should it ensue in the absence of Dr. C., fatal 
consequences might follow. 

The child is still living, as the foetal pulsations heard through the mother's 
abdomen testify. 

There is a chance of saving the child — that chance is lessened by delay, 
owing to the fear of hemorrhage. 

The woman is very anxious respecting her situation, and begs to be de- 
livered. 

Nothing can be gained by procrastination. 

Dr. C. agreed with Dr. S., and requested him to deliver his patient. Pass- 
ing his hand within the os uteri, he grasped the presenting part, the right 
foot, and very carefully and slowly made traction. Uterine pains immediately 
commenced, and, without anything peculiar occurring, the child was delivered 
to the head ; at this stage of labour, although the face was applied to the 
sacrum, some little delay existed in the delivery of the head; it was with- 
drawn, however, by means of the fingers applied to the mouth. 

The placenta was removed without difficulty, or any unusual hemorrhage ; 
and beneath the portion which had been detached, adhered a coagulum about 
the size of an adult's fist. 

The child breathed at considerable intervals of time, for six or eight mi- 
nutes; and the heart beat quite forcibly for a longer time; but all efforts to 
revive it, permanently, failed. 

Recto-Vaginal Fistula in former delivery. Secondary Hemorrhage. — Dr: 
Storer reported the case. On the 4th of August, he was called to attend 
upon Mrs. A., in labour with her second child. 

On the 18th January, 1851, this woman was delivered of a still-child; she 
had been in labour six days when Dr. S. was called in consultation, and the 
child's head had been lying low down upon the perineum an indefinite period. 
Her pains had left her, and her child was dead. On account of the reluctance 
of her friends to have craniotomy performed, Dr. S. was compelled to use the 
forceps; the child was thus delivered, not, however, without an extensive 
laceration being produced of the soft parts of the mother, owing to their ex- 
treme rigidity. For quite a number of weeks she suffered great inconve- 



90 Morland, Extracts from Soc. for Med. Improvement. [Jan. 



nience in retaining the contents of the bowels,, and was made mentally 
wretched. 

Dr. J. Mason Warren remedied the evil, in a great measure, by an ope- 
ration. Patient recovered her health, the power of controlling her sphincter 
ani, and was now again in labour. Dr. S. feared the union between the parts 
would be destroyed by the passage of the child, and he watched the woman 
assiduously, carefully supporting the perineum during the entire period of the 
pressure upon the parts. After ten hours of natural labour, she gave birth 
to a female child, weighing eight and three-quarter pounds, without any in- 
jury being produced. 

After the delivery of the child, a large hemorrhage ensued, proceeding, it 
was found, from beneath a detached portion of the placenta; that organ being 
attached throughout its greatest extent to the fundus of the uterus, and re- 
quiring some care, time, and effort to remove it. 

Dr. S. observed that his patient convalesced as well as usual after confine- 
ment, until upon the 18th ult., fourteen days after her accouchement, when, 
while exerting herself, she had an attack of hemorrhage from the vagina, 
which again recurred on the 22d; a third bleeding taking place on the 25th, 
she became alarmed, and he was sent for. His patient was exceedingly fee- 
ble from loss of blood, and became more so from a continuance of the hemor- 
rhage; and although nearly three weeks have elapsed since he was first called 
to prescribe, but four or five days have passed since he considered her out of 
danger; the bleeding rendering her perfectly anemic, resisting the admi- 
nistration of ergot, matico, Indian hemp, lead, and opium, &c. &c, the 
application of ice, externally, and passed into her womb — and, finally, yield- 
ing to injections into the womb of sulphate of alumina and sulphate of zinc in 
the proportion of 3i each to a pint of water. 

Dr. S. reported this case on account of the late period after the confinement 
at which the hemorrhage occurred. Dr. James Fergusson, in the New 
York Journal of Medicine for September, 1850, reports a case of secondary 
uterine hemorrhage taking place on the thirteenth day after delivery. 

Secondary Hemorrhage after delivery. — Dr. Putnam had lately seen, in 
consultation, a severe case of secondary hemorrhage. The patient, feeble in 
health, was the mother of several children born at intervals of twenty months. 
In some of her labours, had more than the ordinary loss of blood. In the 
present confinement there was no hemorrhage, but the placenta was adherent 
and was extracted with difficulty. Was doing well for four days, when she 
awoke in the night with sudden, profuse flooding. She was much prostrated, 
faint, and frequently vomited ; the pulse rapid and feeble. The treatment 
employed was introduction of ice, followed by plugging the vagina, careful 
bandaging, ergot, brandy, and laudanum. She rallied, and, for three days, 
was improving, when another flooding occurred, attributed by herself to men- 
tal emotion. After an interval of five days she had another hemorrhage equally 
sudden and prostrating, at times being nearly pulseless; but she ultimately 
recovered. One would suspect the presence of some portion of placenta, but 
no remnants were detected in the discharges. Dr. P. referred to a writer who 
had recorded several cases of secondary hemorrhage, and among them one as 
late as the twenty-seventh day. He considered it owing to a menorrhagic 
tendency. 

Dr. Storer asked Dr. Putnam if he considered plugging the vagina a safe 
procedure in such a case. 



1853.] Morland, Extracts from Soc. for Med. Improvement. 



91 



Dr. P. said it would depend upon the amount of contractility of the uterus. 
In the present instance, the contraction was sufficiently firm. 

Dr. Putnam also related a case of hemorrhage from retained placenta, that 
occurred at a late period after miscarriage. A lady of slender constitution 
miscarried at the fourth month without medical attendance. For nine weeks 
afterward she continued to flow moderately, but not enough to prevent her 
riding and walking with freedom. Yery suddenly an excessive hemorrhage 
took place; she became faint and cold. The os uteri was soft, but not dilated 
enough to admit the finger. In addition to the usual stimulants, the vagina 
was carefully plugged with pieces of sponge. At the end of thirty-six hours 
she had so far rallied that the sponge could be removed, and with it the 
placenta, which had in the mean while been expelled into the vagina. 

Dr. P. mentioned another case, in which, under similar circumstances, the 
placenta was retained thirteen weeks. 

Dr. Putnam, at the next subsequent meeting, remarked that, when reporting 
the previous cases of secondary hemorrhage, he quoted some cases from Mr. 
Roberton, having reference to the period of its occurrence and its probable 
cause ; he has since found among his notes another case which illustrates 
these points. 

This was a first labour, in every respect natural. The mother nursed the 
child, and had no inconvenience, except, for the first four weeks, a sensation 
somewhat more than is usual, of "bearing down." The hemorrhage occurred 
six weeks after confinement. She had walked out the preceding day, was not 
fatigued; slept well at night. In the morning had copious discharges from 
the vagina of coagula, with liquid blood. This continued at intervals during 
the day. Dr. P. saw her in the evening. She was frequently faint; the 
pulse at times imperceptible. The uterus could be felt above the pubis; 
pressure there caused a feeling of " bearing down." The vagina was turgid, 
tender to the touch, and filled with coagula. 

The hemorrhage was readily checked by the introduction of ice into the 
vagina. Various stimulants were administered, and, in the course of thirty- 
six hours, reaction came on, without further hemorrhage. 

It may be a question whether this should not be considered an irregularity 
of menstruation; — if so, it confirms the opinion of Mr. Roberton, who, in the 
absence of more probable cause, was inclined to consider it allied to menorrha- 
gia; the discharge being more copious on account of the greater size of the 
uterine vessels, and the greater readiness with which the uterine cavity admits 
of expansion. 

Diagnostic Sign in Tubercular Meningitis. — Dr. Parkman's attention had 
been called by Dr. Slade to what purports to be a diagnostic sign of tuber- 
cular meningitis; it was first announced by M. Trousseau, and consists in 
the appearance of a remarkable red line, remaining upon the skin of the fore- 
head, or of the abdomen, after drawing the finger across it. A female patient 
of Dr. Parkman's, at the hospital, who had tubercular disease of the clavicle, 
was, when about to undergo an operation, seized with fatal illness, which Dr. 
P. diagnosticated as tubercular meningitis. In this case, Dr. Slade pointed 
out the peculiar red line spoken of above. 

The following account was given by Dr. J. B. S. Jackson, of a malforma- 
tion in an adult subject, otherwise well formed, consisting apparently of a 
fusion of two upper extremities. There is one central index finger, and 
upon each side of it a middle, ring, and little finger, seven altogether, and 



92 Morland, Extracts from Soc. for Med. Improvement. [J an. 

perfectly formed ; the index being no larger than natural. The subject of 
this case was a German machinist, aged thirty-seven years ; and the hand was 
not merely very useful in the way of his business, but gave him some ad- 
vantages, he thought, in playing upon the piano, upon which he was a per- 
former. The three upper fingers, supposing the limb to be laid extended in 
a state of semi-pronation, were used efficiently as a thumb to oppose the three 
others. Various observations were made upon the motions of the hand and 
fingers ; and when at last the individual died, under the effects of a chronic 
diarrhoea, the body was sent to the dissecting-room. Dr. J. H. York, who 
had some claims upon the subject, having relinquished them in favour of the 
Society, a cast was first taken for the cabinet, to show the external appear- 
ances. The entire extremity was then removed, and subsequently injected, 
and was fully dissected by Dr. F. S. Ainsworth. The dissection, when 
completed, was shown to the Society, and the specimen is now presented for 
the cabinet, with the following description : — 

The malformation seems to consist of a fusion, by the radial edge, of two 
very imperfectly developed extremities. 

Bones. — The phalanges and metacarpal bones are not remarkable. And so 
of the ten carpal bones, there being upon each side a pisiform, unciform, and 
scaphoid; and upon the median line one semilunar and one trapezoides ; there 
being no trace of a thumb, each trapezium and naviculare is wanting. The 
length of the hand is about seven inches. In the forearm, which is eight and 
a half inches in length, there are two ulnse, but no radius ; the one that would 
be below, when the limb is in a state of semi-pronation, is well developed; 
but the other, though of equal size, is somewhat irregular, the olecranon pro- 
cess being prolonged considerably upwards. The humerus is ten inches in 
length, and has what must be considered as an inner condyle upon each side ; 
also, upon the anterior face, and towards the perfect ulna, a tolerably well- 
developed process, which may be regarded as an outer condyle. The scapula is 
irregularly developed ; the semilunar notch is deep and broad, almost dividing 
the bone across ; the spine is low, so that the fossse above and below can 
hardly be said to exist; with some other deviations. The left upper extremity 
being the one that is malformed, the right ulna is nearly ten inches in length, 
and the humerus thirteen inches. 

Muscles. — The tendons of the latissimus dorsi, teres major and minor, sub- 
scapularis, infraspinatus, pectoralis major and minor, are shown in the pre- 
paration. There is no well-defined biceps, nor brachialis anticus. Coraco- 
brachialis small. One triceps sufficiently developed, with its three heads, and 
inserted into the olecranon of the perfect ulna. A second triceps, however, 
exists, which is quite imperfectly developed ; one head arises from just below 
the head of the humerus, and beneath the deltoid, which has been removed ; 
and a second from the lower part of the humerus, inserted into the imperfect 
olecranon, but sends a tendon to the corresponding inner condyle, and receives 
a large slip from the other triceps : in structure, it is muscular at each extre- 
mity, and tendinous midway. A supernumerary slip of muscle arises with 
the long head of this second triceps, passes under the tendon of the pectoralis 
major, and is inserted into the lower third of the humerus. In the forearm, 
the muscles usually connected with the radius and thumb are of course want- 
ing. The superficial flexor of the fingers arises from the inner condyle, corre- 
sponding to the perfect ulna ; and sends a tendon to each finger, excepting 
the little finger of the imperfect side, also a slip from the tendon of the index 
finger to the deep-seated tendon of the same. No superficial flexor from the 
other internal condyle. Deep-seated flexor, with its tendons sufficiently dis- 



1853.] Morland, Extracts from Soc. for Med. Improvement. 



93 



tinct, arising from both ulnae, and from the interosseous membrane. Flexor 
ulnaris well developed on the perfect side, but on the other indistinct. Ex- 
tensors of fingers very distinct; arose from the two ulnas, and sent a tendon 
to each finger. To the single index finger there are sent two extensors; a 
very interesting fact in support of the general view that has been taken of 
this case. Quaclratus quite well marked, and also the interossei. 

Arteries. — The brachial divides at the lower end of the humerus into two 
ulnars; that which is sent to the perfect side being about one-fourth larger 
than the other. There is also an interosseous of full size. The radial, of 
course, is wanting. In the hand, each ulnar sends a branch to form the 
superficial arch for the three outer fingers, the index being supplied by the 
perfect ulnar; also another for the deep-seated arch, the two inosculating 
freely. 

Nerves. — The radial, which is quite small, enters the triceps muscle, and is 
lost in it. The ulnar of the perfect side is well developed, but the other is 
small. The median is large, and sends a branch to each finger, excepting the 
two little fingers. 

Compound Fracture of the Humerus. — Dr. S. D. Townsend showed the 
specimen, which he had lately removed from a patient, whose arm was crushed 
by a railroad car. The humerus was removed at the shoulder-joint by two 
incisions, commencing at each side of the acromion process, reaching to a 
point at about the insertion of the deltoid, forming a triangular flap, which 
was raised up, and the knife caused to sweep around the head of the bone, 
dividing the vessels, and making a posterior flap. The patient died eight 
days after the operation. A post-mortem examination showed comminuted 
fracture of the scapula. 

Remarkable Case of Aneurism hy Anastomosis. — Dr. J. Mason "Warren 
related the case. A gentleman, fifty years old, partially froze the lobe of 
his left ear, in 1818. This always afterwards remained larger than the oppo- 
site one; and, in fact, slowly increased in size, finally forming a distinct 
tumour, reel on its surface, and having a powerful pulsation. About six months 
since it was found necessary to undertake some means to arrest its growth. 
For this purpose compression between two plates of metal was advised, and 
practised by his surgeon. Although this was done in the most careful and 
scientific way, yet the suffering became so severe that, after having persevered 
with it for a fortnight, it was found necessary to abandon its further appli- 
cation. 

When the patient applied to Dr. W., it was with the full determination of 
having any operation done that might be thought expedient; the tumour 
having arrived at that condition wherein it was evident that, if an operation 
should not be successful in removing it completely, it must soon pass beyond 
the reach of surgery, spreading over the ear and taking possession of the 
face, as in the case cited by Dupuytren, in his Lecons Orales, which resisted 
numerous and formidable operations, performed by some of the most dis- 
tinguished surgeons in Paris. 

The appearance of the tumour at this time was as follows : The lobe of 
the left ear was occupied by a globular tumour, the size of a hen's egg. The 
surface was red, and covered by large veins running over it in all directions; 
the redness and swelling belonging to the tumour extended above, into the 
concha of the ear, and ran up for a short distance on its back part. In front, 
No. XLIX.— Jan. 1853. 7 



94 



Morland, Extracts from Soc. for Med. Improvement. [Jan. 



it slightly encroached on the cheek. On taking it in the hand, it had a 
powerful pulsating motion, not that alone presented by the common erectile 
tumour, but added to this, what might be expected in an aneurism of a large 
artery, the carotid or subclavian, for instance. By manipulation, vessels of 
considerable size could be perceived running into it from the ear and face. 

Dr. W. said that at first he was at a loss how to attack the disease, the 
danger of hemorrhage appearing to be great from any cutting operation, and 
if ligatures were used, the same danger was to be apprehended on the separa- 
tion of the threads. A combination of the two was finally resorted to. 

The patient being etherized with chloric ether, the tumour was dragged 
upon, so as to stretch the integuments as much as possible. A pair of screw 
forceps, similar to an enterotome, was now made to embrace the whole base 
of the tumour, about three inches in length, that is to say, the whole enlarged 
lobe of the ear, with a portion of the cartilage. This was tightly screwed up, 
so as completely to interrupt the course of the blood into it. A needle, 
threaded with a strong double ligature, was' next passed behind the forceps, 
and the needle cut off, leaving the two threads. The tumour, now apparently 
effectually controlled, was cut away close to the forceps. It was, however, 
at once found, that on the tension of the parts being relieved, that portion of 
it towards the cheek had escaped from the grasp of the forceps, and an artery 
was exposed nearly as large as the external carotid. This was seized by 
an assistant with a toothed forceps, and a ligature was applied to it. The 
grasp of the forceps being now slowly relaxed, it was observed that the whole 
cut surface was disposed to bleed at every pore. Some large vessels bled 
violently, and were tied. To stop the bleeding from the other parts, it 
was finally found necessary to apply the ligature en masse, which was done 
by means of two double ligatures. In the subsequent management of the case, 
in which Dr. W. was much aided by Dr. Buckminster Brown, all means were 
used to prevent too high a degree of inflammatory action about the ligatures. 
The patient was kept quiet, a low diet enjoined, and a compress, constantly 
wet with cold water, was applied, and the patient very carefully watched. 
Once or twice blood started by the side of the ligatures, but was restrained 
by refrigerant applications. At the end of fourteen days the ligatures sepa- 
rated, leaving an exuberant granulating surface, upon which the nitrate of 
silver was freely used. On the twenty-third day, the wound was almost 
entirely healed, — and the neighbouring parts were in a perfectly healthy 
state, the effect of the inflammatory action having destroyed the enlarged 
capillary vessels which had extended into the concha of the ear and invaded 
the integuments on its posterior part. 

Dr. W. stated that, in order to have extirpated all appearance of erectile 
tissue at the first operation, by the knife, it would have been necessary to sacri- 
fice nearly half of the ear, and to leave the patient with a great deformity. 
In order to avoid this, he had removed the tumour, trusting to the effect of 
inflammation to destroy the small quantity of erectile tissue which ran from 
it into the adjacent parts. 

The appearance of the tumour after removal was quite interesting. The 
main portion of it was composed of a spongy tissue, similar to that observed 
in a case of which Dr. W. had previously published an account, where an 
inormous erectile tumour of the lower lip was removed, after the previous 
ligation of both carotid arteries. In the present specimen, this erectile tissue 
inclosed an aneurismal cavity, apparently the expansion of the largest of the 
vessels described above, which were tied when the tumour was removed. 
From this cavity, branches extended in all directions, which finally could be 



1853.] Morland, Extracts from Soc. for Med. Improvement. 95 

traced terminating in the cellular tissue which covered the periphery of the 
mass. 

Fissure of the Palate. — Dr. J. Mason Warben showed a case of instru- 
ments containing those most essential in the operation for fissure of the palate. 
He stated that he had always had much difficulty in finding any forceps 
which would effectually seize and control the edges of the fissure during the 
section of the muscles and subsequent removal of its margin. With the 
common double-hooked forceps, too small a portion of the soft parts is 
seized, and, as soon as there is any resistance on the part of the muscles, 
it is torn away. There is also a difficulty in getting one branch of the 
forceps behind the palate, as the tendency of that organ is generally 
rather to hang backwards than forwards. These objections to the common 
forceps he had remedied by having a pair constructed with a double curve 
— one of the carves of the instrument being anterior, the other lateral, and 
the posterior jaw of the forceps being a little longer than the other. By 
means of this instrument, which is provided with double teeth, the smallest 
portion of the edge of the fissure can be seized, and the part held tense 
while the muscles are cut and the edges pared. Dr. W. said that he usualty 
divides the muscles with a powerful pair of scissors, curved on the flat side, 
cutting freely wherever he finds resistance. Sometimes one set of muscles 
requires division, at others another set. When this is effected, the soft 
parts implicated in the fissured palate hang loose, and the subsequent steps 
of the operation can be prosecuted with ease. To show the effect of this divi- 
sion, he stated that in one instance, where the operation had been twice 
repeated on account of want of union, notwithstanding the loss of substance 
from the edges previous to the third operation, which was successful, it was 
observed that they lay in perfect contact, so that, if time had allowed, the 
union might have been produced by the simple application of caustic to the 
angle of the fissure. The voice, previous to the final operation, had much 
improved. 

Dr. W. stated that he had latterly performed five operations, in two of 
which the hard palate was badly fissured, and all had proved successful. 
In one of these, where the fissure extended through the hard palate and 
alveolus, the soft palate and a portion of the mucous membrane which was 
peeled off from the palatine arch, united. The aperture which remained in 
the bones was covered with a gold plate, very perfectly fitted by an expe- 
rienced dentist, and the voice was much improved. 

In regard to the result of these operations, Dr. W. said that he had lately 
seen a young lady on whom he had operated some years since, and the power 
of speech was quite restored, so that she enunciated with great distinctness. 
In almost every case the speech improved, the deglutition was easier, and 
the posterior fauces were less liable to inflammatory attacks, and were relieved 
from the unpleasant state of dryness caused by their unprotected condition. 

Cut-throat; Complete Division of the Cricoid Cartilage and (Esophagus. — 
Dr. Cotting, of Roxbury, sent a full account of the case, of which the fol- 
lowing is an abstract: Mrs. , set. fifty-six, attempted, about four years 

ago, to cut her throat, being then insane. Recovered immediately afterwards. 
Her mother also was insane, and a sister had committed suicide by cutting 
her throat. About a year ago, Mrs. again became insane, and had re- 
cently made preparations to hang herself. A few days before the fatal event 
she returned from an insane asylum. 



96 Morland, Extracts from Soc. for Med. Improvement. [Jan. 

Between 4 and 5 A. M., on the 4th of September, her husband was awoke 
by hearing a knocking below, and, on descending into the cellar, found his 
wife seated upon the floor, by the side of a wash-tub. On being spoken "to, 
she pointed to her neck, about which she had wound a damp towel ; and, her 
condition being then discovered, she was led up stairs, to the second story, 
and placed upon a bed. Nearly a quart of blood was found in the tub, but 
there was not the least bleeding from the wound until examined by the phy- 
sician who was first called. The instrument used was a very dull carving- 
knife. 

About 6 J A. M., Dr. C. saw her, and found a large, gaping, mangled 
wound, rather more than three inches from side to side, and rather less from 
above downwards. Lower half of the thyroid cartilage exposed. Skin and 
integument separated from the trachea, from one to two inches, and extensively 
retracted. At each extremity of the principal incision were smaller ones, 
as from subsequent cuts. Both mastoid muscles deeply cut, and the right in 
at least two places. Cricoid cartilage (or, as was supposed at the time, the 
trachea) and oesophagus completely severed and widely separated, the wound 
extending quite to the spinal muscles; yet the carotids were not injured, 
though they were seen beating, and the right might have been tied without 
any further dissection. Wound filled with blood, but the flow was effectually 
restrained by a single ligature; its entrance into the trachea having been 
prevented by holding up the tube with a hook. The patient appeared de- 
pressed and submissive. Pulse feeble, and not over 60. 

A gum-elastic tube, one-third of an inch in diameter, was first passed 
through the mouth, and downwards, through the oesophagus, until it pro- 
truded from the wound. The lower and deeply-retracted portion of the oeso- 
phagus having then been drawn up, and brought over the extremity of the 
tube, the two portions were secured, and in perfect contact, by three stitches, 
one on each side and one in front; the ligatures being carried by a curved 
needle in Charriere's needle-holder. The tube was then carried on to the sto- 
mach and left there. The larynx and trachea were next brought together by 
strong sutures, one on each side. The integuments were also brought together 
by two stitches, leaving a sufficient opening for the patient to breathe freely 
through the wound. Lastly, the head was brought forward, and the chest 
was supported in a semi-reclined position. 

During all this time, the patient was very tractable, and apparently suffered 
but little. Slight spasmodic action, and scarcely any cough. Pulse rose to 
about 100. After the dressing, she made signs for drink, and about %\\ of 
milk and water were injected through the tube. During the forenoon there 
was "considerable rattling in the throat," as the attendants reported, and a 
slight discharge of mucus from the wound. Some restlessness. Increasing 
pain and uneasiness in the chest, moving from above downwards, and particu- 
larly towards the left side. A little water, given by an attendant, escaped 
immediately through the wound. At 1 P. M., Dr. C. saw the patient, and 
gave ^ij of milk and water through the tube. 

Throughout the day there was a gradual sinking, with one or two slight 
flushes of fever. At nightfall, the pulse was very feeble, but never exceeded 
100. Wound dry and pale, without any appearance of inflammation. Rest- 
lessness increased. Generally appeared sane. In the night, however, she 
attempted to get out of bed, but, after taking forty drops of laudanum, through 
the tube, she slept for about an hour. Retained her consciousness till the 
last, and died about 2 A. M. 

On dissection, the cellular tissue between the oesophagus and the spine, 



1853.] Morland, Extracts from Soc. for Med. Improvement. 97 

from the incision down to the diaphragm, was found to be perfectly infiltrated 
with thin pus of a light yellowish colour, but this did not extend laterally 
nor above the incision. Carotid artery, jugular vein, and par vagum, upon 
each side, uninjured, though the sheath was infiltrated with blood. (Eso- 
phagus gaping posteriorly, but, otherwise, the two portions were in perfect 
contact, as above described. The parts were shown to the Society, with the 
tube and the knife. 

Dr. Cotting remarked upon the following points as interesting in this case : 
The number of incisions, the amount of injury done, and the narrow escape of 
the great vessels. The instrument used. The self-possession during and 
after the deed. The cause of death, as shown by dissection. 

Dr. Stedman spoke of the evident great danger attending the premature 
discharge of inmates of an insane asylum. Cases of suicide in such persons 
are exceedingly frequent. Physicians should discourage such a course when 
asked for advice by the friends of patients in reference to their exit. 

Dr. Gould related two cases of cutting the throat. In the first, the 
sheath of one carotid was opened; the other was not wounded. The patient 
lived from three to four weeks, and died suddenly, while drawing his shirt, 
over his head, being suffocated. In the second case, Dr. G. witnessed the 
suicidal act. A young man severed the trachea with a penknife. When Dr. 
G-. reached him, he fell, and was dead in two or three minutes, turning purple 
in the face. The jury of inquest, among whom were some medical men, 
returned a verdict of death by bleeding from wounds inflicted by a penknife ; 
implying death by amount of the hemorrhage; whereas Dr. Gr. thinks it was 
by the mode of the bleeding — the lungs being filled with blood, and suffoca- 
tion ensuing. 

Dr. J. M. Warren remarked the rarity of instant death in these cases. 
He had never seen the carotid artery or the jugular vein divided in such 
attempts, and he remembered no fatal case except the one just related by Dr. 
Gould. 

Dr. Hayward, Sen., never saw an instantly fatal case. He thinks the 
lingual artery is the one most commonly divided. Dr. H. avoids immediate 
closure of the wound by suture; there is greater danger of suffocation. 

Dr. J. B. S. Jackson referred to two cases of immediate death consequent 
on cutting the throat. In reference to Dr. Cotting's case, he remarked the 
probable influence of the inflammation of the cellular tissue, which had super- 
vened in so short a time, with formation of pus. This may have had some- 
thing to do with the production of the fatal result. 

Dr. Homans had seen several cases. In one, death was instantaneous. 
A razor was used, severing the left carotid. In another, the carotids were 
untouched, but death followed in a few minutes. 

Dr. J. M. Warren said that, in the greater number of cases, a razor is 
the instrument used, and the throat is cut while the head is ihroion backwards. 
The large vessels are thus rarely reached, much protection being afforded by 
the muscles of the neck. Generally, patients are discovered in time to pre- 
vent fatal hemorrhage. 

Dr. Homans related the case of a man, forty years of age, who had made 
three unsuccessful attempts to take his own life by cutting the throat. He 
now has a fistulous opening into the trachea. 

Dr. Bigelow, Sen., mentioned an instance. A man, in a sudden fit of 
raving delirium, leaped out of a chamber-window, through the glass. After- 
wards, he deliberately cut his throat with a razor, standing before a looking- 
glass, and resisting the efforts of his wife to prevent the act. He immediately 



98 



Morlandj Extracts from Soc. for Med. Improvement. [Jan. 



fell, bleeding copiously. Recovering from the consequent syncopic state, lie 
violently opposed those who endeavored to dress the wound; but, on being 
assured that he could not recover, he became quiet. Collapse came on, and 
he died in the course of the same day. 

Dr. J. M. Warren remarked that, very probably, if this patient had not 
been so strongly opposed in the first place, the wound might not have proved 
fatal. 

Chronic Ulcer of the Leg; Amputation; Fatty Degeneration of the 
Muscles. — Dr. J. B. S. Jackson showed the limb, removed by Dr. S. D. 
Townsend, on Saturday last, at the Hospital. The patient is a man of sixty 
years; at the age of twenty-four, he cut the knee-joint open with a broad-axe; 
confinement to bed for four months followed the accident; abscesses forming, 
with threatened loss of the limb; the joint finally became anchylosed; the 
limb in a straight position. A few years subsequently the ulcer commenced, 
and has continued till this time, about thirty years in all, and was very ex- 
tensive at the period of amputation. 

There is complete fatty transformation of almost the whole of the gastroc- 
nemii muscles. In the integument near the margin of the ulcer were found 
several small, thin plates of bone. The bones of the leg were enlarged and 
rough, as is usual in old ulcers. 

October 11. — Peculiarity in Dentition. — Dr. Coale related an instance of 
conservation of the first teeth to adult age; the subject being the mother of a 
child now under his care ; two other individuals of the same family present 
the same peculiarity. In another patient, a young lady, the two eye-teeth 
and two stomach-teeth are all that exist ; the first teeth having been shed, 
they were never replaced, except by the above four. 

Tumour of the Cervix Uteri; Removal by Caustic Potash. — Dr. Putnam 
reported the case. Two months since, the tumour projected an inch from the 
cervix uteri, and was of the size of a large horse-chestnut; much hemorrhage 
at times ; always greater at menstrual periods. Caustic potash removed the 
growth, entirely. In another similar case, the tumour nearly filled the va- 
gina, and under the same treatment is now disappearing. Dr. P. remarked 
that the use of this caustic had been, by some, considered dangerous ; likely 
to induce peritoneal inflammation. Dr.' Simpson, of Edinburgh, states that he 
had never noticed this effect to follow the use of the potash, whereas he had 
observed it after the actual cautery. 

The precaution of using vinegar with the potash was insisted on by Dr. P. 

Dr. Channing spoke of the very free employment of the caustic potash in 
disease about the neck and mouth of the uterus, which he had lately wit- 
nessed in Europe. No pain is felt by the patient ; the caustic is introduced 
through the canal of the speculum vaginas. Dr. C. exhibited to the Society 
the instrument used by Dr. Simpson, of Edinburgh, for applying the above 
caustic; vinegar is always employed in conjunction. Dr. Simpson's instru- 
ments for division of the cervix uteri, for the removal of uterine polypi, and 
for the application of the sponge-tent, were also shown by Dr. C. 

Fibro-Plastic Tumour of the Neck. — Dr. Henry J. Bigelow showed 
this, removed from a boy of ten years; it had not the characteristics of the 
common fibro-plastic tumour when externally examined; it was smooth; very 
elastic; movable under the skin; not lobulated. 



1853.] Morland, Extracts from Soc. for Med. Improvement. 99 

When one year old, this boy had two or three small bunches under the 
ear; these subsequently fused into the tumour now removed. When first 
examined, there was an inflamed gland just beside it, and it was suggested 
by some medical gentlemen who then saw the patient, that the tumour itself 
might be a gland chronically inflamed. It was cut down upon and very easily 
slipped out; an abscess formed in the wound; the tumour itself is fibro-plastic, 
of the softer kind ; resembling isinglass in consistence, and is opaline in as- 
pect. Dr. B. referred to a case in which a similar tumour was recurrent 
after removal. A drawing of the entire tumour, and another of a section 
thereof, both finely coloured, were exhibited by Dr. B., in conjunction with 
delineations, by himself, of the microscopic appearances ; the cells observed 
were regular in their form, and had small nuclei. 

Destructive Disease of the Nose, Larynx, and Trachea ; with the Specimens, 
and a cast of the Face, &c. — The account of this case was communicated to 
the Society by Dr. J. B. S. Jackson, who received it from Dr. Edwin Leigh, 
of Townsend. 

The patient was a girl, nineteen years of age; six years ago she was trou- 
bled with earache ; the cervical glands were occasionally much enlarged ; at 
times there were large swellings under the tongue, which would open and dis- 
charge matter. Subsequently her breath became extremely offensive. She 
reported herself to be continually u getting a netu cold in her head;" she 
would sneeze, with accompanying discharge from the nostrils, and the tears 
would overflow, as in cases of obstructed lachrymal duct. 

About two years since, while " picking her nose" with a pin, she was sur- 
prised to find that its head passed entirely through the septum nasi ; she then 
became aware, for the first time, of the existence of ulceration of the nares. 
Previously to this, and about the time her breath became disagreeable, the 
voice began to be affected. The ulceration progressed (in spite of, or aided 
by various treatment), involving not only the mucous membrane, but also the 
cartilaginous and bony parts of the septum, until about eight months since, 
when it healed, as is shown in the east. The posterior wall of the pharynx 
presented a whitish, fibrous, irregular, cicatrix-like aspect ; the velum palati 
and the uvula were gone ; the posterior opening of the nares had assumed a 
form nearly circular. Within the last two months there has been no appear- 
ance of active disease in this region. The patient's respiration has been dif- 
ficult for a year or more. About one year previous to last January, she lost 
her voice entirely ; since that time she has regained a hoarse, rushing, un- 
natural sound, half distinct voice, half whisper ; hardly entitled to the name 
of voice. Dr. Leigh was first applied to by her in June last, when she de- 
sired a cough syrup; no very particular inquiries were made, as she did not 
ask for advice, but Dr. L. noticed the peculiar sound substituted for the natu- 
ral voice, and the rough, noisy respiration, such as is produced by partially 
closing the glottis when we whisper; her inspirations and expirations were 
remarkably long and deep. Two months since she again applied, and for 
advice ; her abdomen was very much enlarged ; there was abundant ascitic 
collection, which had supervened imperceptibly, and was noticed only one 
week previous to her second application ; within a few days it had very rapidly 
increased, unattended by pain or tenderness. On examining the patient, not 
the least sign of puberty was apparent; a great enlargement of the base of 
the thorax, as compared with its apex, was not remarked until subsequently, 
from its apparent connection with the ascites. In about a fortnight the ascites 
disappeared, under the administration of hydragogue cathartics. 



100 Morland, Extracts from Soc. for Med. Improvement. [Jan. 



In September, the patient sent for cough syrup, and soon after this Dr. L. 
was summoned in the night to see her suffering great dyspnoea and inability 
u to raise," as she termed it. Relief was afforded by an emetic; since then, 
dyspnoea has been frequent, with occasional suffocative access, relieved as soon 
as she could (to use her own expression) " loosen the phlegm." The sputa 
were purulent. The disease, which had already destroyed the nares, was so 
manifestly progressing in the trachea, that Dr. L. did not encourage her friends 
in reference to her recovery, even should it happen that the local disease 
should cease; no doubt existing in his mind, that, in such event, the cica- 
trices, in their contraction, would augment the dyspnoea ; the danger was, 
therefore, fully announced to the friends. 

Thus far she had complained of nothing but dyspnoea ; there was no sore- 
ness or pain in the nares or fauces; no pain in the chest or hypochondriac 
regions. On Tuesday morning last, Dr. L. was called in haste; he found his 
patient dead on his arrival. She had appeared more comfortable than usual 
the previous evening; had rested well in the night, coughing but once or 
twice ; a large quantity of muco-purulent matter had thus collected. At 
3 o'clock A. M. she knocked on the wall (as was her habit when an attack of 
dyspnoea came on), and an instant afterwards she was found standing at her 
bedside, struggling for breath; she did not breathe fairly afterwards, being 
unable to inspire ; the accumulated mucus and pus had suffocated her. 

On dissection, there was found almost continuous ulceration from the glottis 
to the bifurcation of the trachea. The disease was in different parts more or 
less acute, the posterior surface being mostly affected. There was also dis- 
tinct evidence of previously existing disease; the cicatrices that had resulted 
from former ulceration being traversed by a curious interlacement of whitish, 
shining fibres, and the cavity of the larynx being almost divided by a broad, 
thin, glistening septum which ran obliquely across it. At one part, the con- 
traction of the passage that resulted from the development of this fibrous tis- 
sue was such that a goosequill would hardly have passed. The general ap- 
pearance of the surface was quite different from that of common ulceration of 
the air-passages; there was also a peculiar relaxation or bagging out of the 
trachea posteriorly at certain parts ; some of the rings were denuded ; no 
tubercular deposit. In the chest there was found pneumonia, with pleural 
effusion, but no tubercles. The liver was a large, shapeless mass, almost 
completely adherent to the neighbouring parts, and nearly filled with a pecu- 
liar form of tubercular deposit; much of it being opaque, yellowish, and 
cheesy in appearance, though generally having almost a scirrhous density. 
Spleen much enlarged; eight by five and a half inches; uterus most remark- 
ably undeveloped ; peritoneum much discoloured ; in its cavity were a few 
pints of serum. 

A cast of the face, showing the loss of the nose, also the larynx, trachea, 
and a portion of the liver, sent by Dr. L. with the history of the case, were 
exhibited to the Society. 

Dr. Jackson suggested that this disease might, perhaps, be considered as a 
form of lupus, affecting the mucous membranes primarily, instead of second- 
arily, as it sometimes does; he had met with a somewhat similar case several 
years ago, in a little girl. He remarked on the extensive tubercular affection 
of the liver when the lungs were quite free from this disease, and on the ex- 
treme rarity of this form and amount of disease of the liver under any circum- 
stances; the fact of the deposit being tubercular was not merely apparent to 
the naked eye, but had been proved microscopically by Dr. Bacon, so far as 
it could be. The disease of the liver probably followed long after that of the 



1853.] Morland, Extracts from Soc. for Med. Improvement. 101 



mucous membranes. The enlargement of the spleen, as a consequence of the 
obstruction that must have existed in the portal circulation, is interesting in 
connection with what is occasionally observed in the case of granulated liver. 

Monstrosity. — Dr. Jackson exhibited a six months' foetus, which he had 
received from Dr. Z. B. Adams, and in which the contents of the abdomen 
protruded, forming a large mass or tumour, covered by a thin membrane, 
and adhering broadly and intimately to the placenta. The umbilical vein, 
which was, of course, very short, ran along the surface of the mass, and 
entered the liver upon its convex face. The cuticle was extensively separated, 
and death had probably occurred about three weeks before delivery ; the organs 
of the abdomen were, therefore, very soft, and being also universally and very 
closely adherent, no proper dissection could be made. The liver appeared to 
consist of a single .lobe ; bladder very large, the urethra being long but very 
small; no genital organs found; externally, something like labia on each side 
of the urethra; no anus. The pelvis was very much malformed; the ossa 
innominata being imperfectly developed, situated quite behind the spine, and 
disconnected in front. Dr. J. remarked that he had seen several cases of pro- 
trusion of the contents of the abdomen, but never before one in which there 
was an adhesion to the placenta. 

Extensive Fracture of the Spinal Column; Complete Division of the Cord ; 
Life continuing two months. — Dr. Parkman presented the specimen for the 
Society's cabinet. The principal fracture was through the body of the fifth 
dorsal vertebra, and, the bodies of the third and fourth being separated from 
their laminae, were shot in front of the sixth and seventh. The displaced bones 
were firmly ossified in their new situations. The specimen was sawn through 
perpendicularly, and the division of the cord was seen to be complete. The 
symptoms were those common to these cases. The point of interest was the 
long continuance of life under these circumstances. Dr. P. stated that death 
usually occurs before the expiration of the fourth week. 

Pulmonary Disease of doubtful nature; at first supposed to be u Acute 
Phthisis." — Dr. Bowditch presented a portion of lung containing, appa- 
rently, miliary tubercles, taken from a man who had died with some of the 
symptoms of acute phthisis; and in whom both lungs were found studded 
with substances similar to those seen in the specimen presented to the 
Society. Dr. B. considered it as presenting, to the naked eye, all the ap- 
pearances of miliary tubercles as distinctly as he had ever seen them. He 
examined them microscopically, with Dr. Bacon, for the purpose of seeing 
the peculiar cells of tubercle, but, to his surprise, none could be discovered. 
Dr. B. asked the opinion of the members upon the appearance of the speci- 
men, and requested Dr. Williams to give an account of the case, and Drs. 
Bacon and Durkee to state the microscopic results obtained by them. 

Dr. Williams gave the following as the chief facts in the case : The pa- 
tient was a journeyman printer, aged twenty-three. On the 6th inst., when 
in apparent good health, was aroused from sleep by pulmonary hemorrhage. 
During the five succeeding days he had several attacks of haemoptysis, and on 
the 9th, a considerable hemorrhage from the bladder. He was apparently 
recovering from the effects of these, when the respiration, which previously 
had been unembarrassed and without marked abnormal auscultatory pheno- 
mena, became oppressed. Crepitation began to be heard in the right lung, 
afterward extending to the left, and followed by mucous rale. The expecto- 



102 Hammond, Use of Potash in Treatment of Scurvy. [Jan. 



ration consisted almost wholly of frothy mucus. The chest was everywhere 
resonant on percussion. At the autopsy, on the 24th, the resonance was 
explained by the existence of vesicular and interlobular emphysema. Both 
lungs were filled with small globular masses, apparently miliary tubercles. 

Dr. Bacon stated that, on a microscopic examination, he was satisfied there 
was no tubercular cell to be found ; that there were many inflammation cor- 
puscles, and certain cells looking somewhat like those of encephaloid matter. 
On this latter point, however, he could not speak definitely. 

Dr. Durkee agreed with Dr. Bacon upon the non-existence of tubercle, 
and also upon the presence of inflammation corpuscles. 

Drs. John Ware and J. B. S. Jackson considered the specimen, pre- 
sented by Dr. Bowditch, to have all the common characters of miliary tu- 
bercle. 

Dr. Bowditch thought the case interesting, as showing the importance 
of the microscope. He asked if it be possible that most cases of so-called 
acute phthisis, are, in reality, only simple inflammation of the vesicles? 
Finally, Dr. B. suggested that the case might be one of those called by 
Rokitansky vesicular pneumonia. (Pathological Anatomy : Sydenham Society 
Edition, vol. iv. p. 83.) 

[The correctness of the microscope, as a means of diagnosis, is in ques- 
tion, in this case. If the granulations or bodies observed were tubercular, 
upon the grounds of evidence hitherto universally received as satisfactory, 
then either the microscope is not to be relied upon, finding no proper tu- 
bercular cell, or the said grounds of evidence must be renounced. It is 
more according to reason to consider the case, as Dr. B. has suggested, 
"vesicular pneumonia;" especially as Rokitansky asserts, that the "pro- 
duct of such inflammation, under certain conditions, partakes of the nature 
of tuberculous matter;" — but such partaking does not necessitate the dis- 
covery of the cell of tubercle by the microscope j that discovery would at 
least be doubtful, if not unlikely j yet the naked e} r e might readily pro- 
nounce these depositions tubercular granulations; hence, indeed, " the import- 
ance of the microscope" is most apparent, — Secretary.] 



Art. V. — Observations on the Use of Potash in the Treatment of Scurvy; 
with Cases. By William A. Hammond, M. D., Assist. Surg. U. S. 
Army. 

Hitherto, in the treatment of scurvy, little reliance has been placed by 
physicians in medicines, strictly so called. Fresh vegetables, lime-juice, &c, 
have been regarded as indispensable to the cure of this disease ; and in situa- 
tions where these articles could not be obtained, the unfortunate patient has 
generally lingered out a miserable existence till relieved from his sufferings by 
death. 

The researches of animal chemistry have, at length, however, thrown some 
light upon the pathology of scurvy; and if future observers confirm the 
results derived from the following cases, it will not be the least boon which 
that science has conferred upon the practice of medicine. 



1853.] 



Hammond, Use of Potash in Treatment of Scurvy. 



103 



New Mexico, where the following cases occurred, presents to the physician 
a wide field for the observation of scurvy. During eight months of the year, 
it is exceedingly prevalent among the troops stationed in this territory, and 
from the scant vegetation of the country, it is impossible to obtain those 
vegetables generally esteemed most beneficial in the treatment of the disease 
under consideration. Perhaps, however, I saw less of scurvy than any medi- 
cal officer stationed in New Mexico. There did not originate among the troops 
serving at the post with me more than four or five cases, out of twelve ad- 
mitted into the hospital, and those were generally of a mild nature. This 
immunity from, the disease I ascribe to the fact, that the small stream which 
flows past the post (the water of which was used by the troops) contains potash 
in quite an appreciable quantity. From one of the springs situated among 
the mountains, which supply the main stream, I obtained very satisfactory 
evidence of the existence of potash in considerable abundance, a large pre- 
cipitate of the bi-tartrate being thrown down by a solution of tartaric acid. 

A small portion of some salt of potash (say the bi-tartrate, as the most 
agreeable), issued to the troops as a component part of the ration, would, I am 
confident, entirely prevent the occurrence of this affection among them. 

The cases here presented are selected from about a dozen others as being 
those in which the disease was farther advanced before being placed under 
treatment. 

Case I. — William Henry, a private in company "K," 2d U. S. dragoons, 
admitted in hospital at Cebolleta, New Mexico, January 2, 1850, with scor- 
butus. Has been on detached service to Santa Fe, and while there became 
affected. Countenance sallow and bloated, breath extremely fetid, and gums 
exceedingly tender, bleeding profusely upon the slightest touch. Legs and 
thighs covered with the characteristic livid spots; stiffness of the knee and 
ankle-joints, and slight oedema of the feet. Ordered, potass, carb. grs. v, ter 
in die, and sol. aluminis, for mouth. 

January 3. Much improved; continued medicines, 4th, 5th, 6th, and 7th; 
continued to improve ; ordered medicines as before. 

Sth. Gums hard and firm; maculae on legs and thighs entirely gone; com- 
plexion clear, and general health restored. Omit medicine. 

9th. Discharged hospital, cured. 

Case IT. — Augustus Miller, private 2d dragoons. Admitted into hospital 
May 26, 1850. Has been affected with scurvy for three weeks, at Albu- 
querque, New Mexico, and has been under treatment for it. Does not know 
what was given him. Transferred with his company to this post May 25, 
1850. Says he feels a little better since his arrival here. Has some pain in 
right leg, at seat of a fracture which occurred some years since. Maculae on 
legs and thighs very abundant, and two or three large extravasations of blood 
about the ankle-joints of each leg. Bowels regular. Ordered potass, carb. 
grs. v, ter in die. 

28th. Spots on lower extremities disappearing; skin over fracture livid in 
appearance, and slight motion can be perceived at the fractured part. Con- 
tinued medicine as above. 

29 th. Improving. Pain in leg much less. Motion of fractured parts slightly 



104 Hammond, Use of Potash in Treatment of Scurvy. [Jan. 

perceptible. Extravasation fading. G-ums firm, and healthy in appearance. 
Committed some indiscretion in his diet to-day, in consequence of which he 
became affected with dysentery, which required very active treatment. Potass, 
carb. was omitted on the 31st, and on June 1st all signs of scurvy had dis- 
appeared. He is much debilitated from the effect of the dysentery, which 
still continues. 

June 7. Convalescent. Continued to gain strength, and on the 12th was 
discharged hospital, and returned to duty. 

Case III. — Rafael Garcia, a Mexican, has been affected with scurvy for a 
month or more at Belin, New Mexico, where he has been on a visit to his 
friends. First noticed ^the disease at that place. Returned to this village 
June 5, 1850. I first saw him on the 7th. Gums exceedingly tender and 
spongy ; teeth very loose, and sore to the touch. Has several large extrava- 
sations of blood on his legs, and myriads of the characteristic spots. On the 
anterior surface of the left leg is an ulcer three inches in diameter, of a pale, 
indolent appearance ; knees stiff, flexed on the thigh, and very painful on any 
attempt to extend them. Ordered potass, bi-tart. 5j> ter in die. This me- 
dicine was cod tinned for two weeks, at the end of which time all signs of 
scurvy had disappeared, with the exception of the stiffness of the knees. By 
friction and careful passive motion for a week, the free use of these joints was 
completely restored. The ulcer of the leg healed perfectly without the use 
of any local application but ung. simp. 

These cases are, I conceive, sufficient to prove the benefit to be derived from 
the use of the salts of potash in the treatment of scurvy. Others could be 
adduced; but as they are generally similar to the above in all essential par- 
ticulars, I have not thought it necessary to introduce them here. In regard to 
the most eligible combination of potash, I am inclined to think the bitartrate 
preferable. It is more generally relished by patients, and, independently of 
this advantage, I think its purgative and diuretic properties beneficial. Both 
this and the carbonate, however, becoming exhausted at the post, I adminis- 
tered several other salts of the same article, both separately and with citric 
acid, without, however, perceiving that the latter article at all accelerated the 
cure. 

No vegetables were given to the patients, for the simple reason that they could 
not be procured. They certainly would have proved powerful adjuncts to the 
potash in the treatment of the disease ; but from the arid nature of the soil 
of the country, it is impossible to obtain them, even when in season, in suf- 
ficient quantities for the use of the sick alone. 

In situations where the water has not a chemical constitution resembling 
that of Cebolleta, I should think it expedient to increase the quantity of pot- 
ash given at each dose considerably over that indicated by the above cases. 
I did not, however, find it necessary to administer to any over two drachms of 
the bicarbonate thrice daily, and this quantity was given but to one patient. 

In all, twelve cases of scurvy were treated with the salts of potash. Of 
these, four originated at the post, the remainder in different parts of the ter- 
ritory. All recovered perfectly, and in no case did lameness or other deformity 



1853.] Haskins, Critical Remarks upon the Arcus Senilis. 105 

remain. The minimum period of treatment was three days, the maximum 
twenty-one days, the average nine days and six-tenths. 

In regard to the modus operandi of potash in scurvy, I think the hypo- 
thesis of Dr. G-arrod, of London (to whom I am indebted for the idea of its 
curative properties), correct. He regards the disease as depending upon a 
deficiency of potash in the blood, and considers it essential to the perfect 
nutrition of the muscular fibre.* The urine of each patient whose case is 
here related, as also that of all in whom it was examined, exhibited, before 
treatment, a total absence of potash, and I noticed that, as this substance 
appeared in the urine, amendment commenced. 

The action of this remedy must be seen, in order to be properly appreciated. 
The return of strength to the body, cheerfulness to the mind, and the speedy 
disappearance of all symptoms of the disease which ensue so quickly upon its 
administration, liken its influence more to that of a charm than aught else. 

The importance of the discovery of the curative properties of potash in the 
treatment of scurvy cannot be too highly estimated. In our own country, 
especially, will it prove a most valuable acquisition. Scurvy has been the 
scourge of the numerous parties of overland emigrants to Oregon and Cali- 
fornia j more, probably, having been affected among them by this disease than 
all others combined, and numbers have, in consequence, left their bones upon 
the plains. From the facts previously mentioned in this article, I am satisfied 
that not only as a remedy is potash valuable in scurvy, but that as a prophy- 
lactic, also, its qualities entitle it to a high rank among that class of agents. 
On the score of economy, a better one could not be obtained. 

The attention of physicians is invited to this subject. It is only by nu- 
merous experiments that the efficacy of this article can be established on a firm 
basis, and if these are made, they will, I think, have as much reason to be 
satisfied with its action as myself. 



Art. Yl.~Some Observations and Critical Remarks upon the Arcus 
Senilis, as a Diagnostic Symptom of Fatty Degeneration of the Heart. 
By E. B. Haskins, M. D., of Clarksville, Tenn. 

In the London Lancet, for May 11, 1850, Mr. Edwin Canton, Assistant 
Surgeon to the Royal Westminster Ophthalmic Hospital, &c, has published 
some interesting " Observations on the Arcus Senilis," 

He claims to have demonstrated what had only been hinted at by "Dr. 
Schon of Hamburg," that the senile arc consists in a fatty degeneration of 
the cornea. 



* See American Journal of the Medical Sciences, July, 1848, pp. 200-203. 



106 



Haskins, Critical Remarks upon the Arcus Senilis. 



[Jan. 



That portion of Mr. Canton's paper, however, of greatest practical bearing, 
has reference to the supposed coexistence of the fatty degeneration of the 
heart with the arcus senilis. Upon this subject the author remarks : — 

" It would be interesting to learn whether in those cases of fatty degenera- 
tion of the heart, which have of late years been recorded as occurring under 
the age of forty, there existed in the eyes any trace of that appearance which 
is indicative of the like condition of the cornea. I have in no instance found 
this senile arc, when well developed, unaccompanied by fatty degeneration of 
the heart. The oceular muscles have been always more or less in the same con- 
dition, and the extent of the degeneraacy in them and in the heart, has ap- 
peared to me to bear a relation to the degree to which the cornea has been 
invaded by the deposit." — Lancet, May 11, 1850, p. 561. 

In the same journal, Nos. for Jan. 11 and 18, 1851, in a second paper, 
Mr. Canton continues his observations upon this subject. After reiterating 
the quotation I have made, with the latter part of the extract italicized, he 
goes on to say: — 

" Since penning these observations, I have had frequent additional oppor- 
tunities of inquiring into the subject, and find them to be more fully borne out 
by extended experience. 

" On discovering that the senile zone was produced by fatty degeneration of 
the cornea, I at once became desirous of ascertaining whether or not this 
appearance might be looked upon as an exponent (so to term it) of similar 
changes going on in other textures of the body ; textures, the degeneracy of 
which we might suspect, but could not, during life, pronounce with certainty 
upon ; and the fact being established, that the alteration in the cornea was of 
this peculiar character, and with it was to be found associated the same change 
in internal organs ; a clue might thus be given to certain obscure affections, 
and a valuable aid to diagnosis be thereby secured. 

"In endeavouring to establish the validity of this position, from frequent 
post-mortem inquiry, I found that the heart is, of all other organs, the one which 
most invariably presents fatty degeneration where the arcus exists ; and the 
extent of change in the cornea, I believe I have good reason to say, may be 
regarded as a measure of the degree to which the heart-fibre has, in the same 
manner, become changed. Jan. 18, p. 67. 

* * * * * * 

" Since announcing the fact of the coexistence of this condition of the heart 
with an arcus senilis, I have been much pleased to find that two high authori- 
ties on diseases of this organ (Dr. C. J. B. Williams, and Dr. R. Quain) have 
directed their attention to the subject, and that they, too, consider the presence 
of the arc as a diagnostic sign of this affection. * * * Dr. Williams remarks 
in his letter : ' In the foregoing cases, fatty degeneration of the heart was sus- 
pected, from the existence of symptoms of embarrassment of the circulation 
and respiration, not referable to any other lesion, the disorder being connected 
with a declining state of the general health, too enduring to be ascribed to 
merely functional disturbance. The preceding table* shows the existence of 
the arcus in the large proportion of twenty-three out of twenty -five cases. Out 
of these I have been able to prove the existence of fatty degeneration of the 
heart, by post-mortem examination in only two cases.' "f Jan. 18, p. 68. 

* The reader is referred to Mr. Canton's paper in the Lancet for Jan. 18, 1851, p. 
68, for the table of Dr. Williams's cases. 

f We are not informed from this language, whether or not these two cases embrace 
all of the post-mortem examinations made of the twenty-five cases. It is presumed, 
however, from Dr. W.'s high character for candor, and devotion to medical truth, that 
they do. 



\ 



1853.] Haskins, Critical Remarks vpon the Arcus Senilis. 107 

Allowing all that can be claimed for these observations that where fatty 
degeneration of the heart exists, the arcus senilis is generally present, they by no 
means show the converse — that where the arcus senilis is found the fatty degene- 
ration of the heart exists. For this end, another and somewhat different line 
of research must be instituted. It must be inquired how often, in a given 
number of subjects with the arcus senilis, the fatty condition of the heart is 
found, or suspected, from symptoms and other signs. I know that Mr. Can- 
ton distinctly states, that " I have in no instance found this senile arc, when 
well developed, unaccompanied by fatty degeneration of the heart." Yet I 
understand from his paper, that in his cases, as in those of X>r. Williams, the 
observations were made upon patients — upon subjects who were suspected of 
this change of the histological elements of the heart. 

In order in some slight measure to fill up this deficiency, to ascertain, as 
far as I could, what reliance may be placed on the arcus senilis as a diagnostic 
sign of heart affections ; or, in what way this change in the cornea is related 
to other morbid conditions of the body, as manifested by symptoms, I have 
carefully recorded every case of arcus senilis that has fallen under my notice 
within the last three months, together with the symptoms, medical history, 
&c, of the subjects ; and, though only twelve in number, I cheerfully submit 
them for publication; fully concurring with Mr. Canton, however, that "it is 
by extended investigations alone we may hope to arrive at the maturity of 
truth." 

Out of the twelve cases here recorded, it will be noticed that only two 
laboured under any symptoms referable to the heart, and only one where any 
organic alteration of that organ could be at all suspected, the palpitation, in 
the other case, being clearly of hysterical origin. One case laboured under 
phthisis pulmonalis; one under indigestion; one had paralysis agitans, and 
one other neuralgia. Six of the twelve subjects, or one-half, were healthy 
individuals. Three, or one-fourth, were under forty years of age, and two of 
them were quite healthy; the other had indigestion. One, or one-twelfth of 
the whole, was under thirty, and he a young man of remarkable health and 
vigour. 

It may be objected that, as the subjects of these cases are all living, no- 
thing can be afiirmed of their internal structures, whether there is going on 
fatty degeneration of the heart or not. To this it may be answered, that the 
absence of the symptoms and signs of disease always raises the presumption of 
health, and to point to the arcus as the sign in these cases, is to assume that 
which is to be proved. Besides, if the " extent of change in the cornea," 
which Mr. Canton remarks he has good reason to believe " may be regarded as 
a measure of the degree to which the heart-fibre has in the same manner be- 
come changed," then, as some of Dr. Williams's cases, where the arcs were 
slight, the symptoms of heart-disease were marked, it would be presumed that, 
in my cases, where the development of the arcs was marked, the symptoms of 
heart-disease would, at least, be perceptible. 



108 Haskins, Critical Remarks upon the Arcus Senilis. [Jan. 



It is true, Mr. Canton declares that he intends his " observations to apply 
only to instances where the arcs are being established as other manifestations 
of the decline of life are becoming developed, or where perversion of nutrition, 
occurring at earlier periods of existence, involves in its transformation the eye, 
as it at the same time implicates the heart-fibre with other and dissimilar tex- 
tures." But if, as my cases tend to show, there are general causes acting to 
produce the senile arc, that do not, at the same time, involve the structure of 
the heart, or that there are local ones operating to produce the arc, the seat 
and nature of which cannot be ascertained, then it would appear that the value 
of the senile arc, as a diagnostic sign of fatty degeneration of the heart, is les- 
sened in a direct ratio with the frequency of action of those causes; and as 
the cases I have submitted do show that the senile arc is quite common in 
subjects where no symptoms exist involving the healthy condition of the heart, 
and where no local cause of the change is ascertainable, it would then seem 
that the senile arc is of hut little or no practical value, as yet, to determine the 
seat and nature of obscure diseases. 

These remarks, it is believed, will not be considered inappropriate, when 
it is remembered that there are many obscure chronic disorders that involve, 
in a chain of organic relations, the healthy functions of the heart and lungs, 
that may prove amenable to treatment, and that would be abandoned to pal- 
liatives, were they determined to be owing to a histological degeneration for 
which no remedy is known ; and when, too, it is considered how prone we all 
are to seize upon some simple and easily recognized sign as pathognomonic, 
that both covers our ignorance and curtails the labour of careful and patient 
investigation. 

It may be remarked, in conclusion, that the cases recorded in the following 
table tend to confirm the observations of Mr. Canton, that the arcs are equally 
and symmetrically developed in both corneae j and that they differ from his in 
showing the probability of the change commencing (when any difference exists) 
in the lower border of the cornea. Six cases, or one-half, present the lower 
arc in the most advanced state of development, whilst in the remaining six 
the arcs were equally developed above and below. In two, or one-sixth of 
the cases, the presence of the lower arc alone was discovered. 



1853.] 



Haskins, Critical Remarks upon the Arcus Senilis. 



109 



Colour 

of 
subject. 



Age. 



White 



White 



Black 



Black 



Black 



White 



White 



White 



White 



White 



White 



White 



M. 



M. 



M. 



M. 



M. 



M. 



M. 



m; 



62 



90 

(?) 



38 



60 



61 



Si 



Colour 
of 
eyes. 



Dark 
blue 



Dark 
hazel 



Black 



Black 



Black 



Light 
blue 



Light 
blue 



Light 
blue 



BlacI 



Light 
blue 



Dark 
hazel 



Light 
blue 



Pathological 
state of eyes. 



Social condition, medical history, &c. 



Arc above and 
below on both cor- 
neas. Well deve- 
loped on lower. 

Deep and well- 
developed zone on 
both corneas. 



Well-defined zone 
on both corneas. 



Well-marked zone 
on both corneas. 



Well-marked zone 
on both corneas. 



Upper and lower 
arc on both cor- 
neas ; lower most 
developed. 

Upper and lower 
arc on both cor- 
neas; loioer well de- 
veloped, upper in- 
distinct. 

AVell-defined zone 
on both corneas. 



Lower arc dis- 
tinct on both con- 
neas ; upper feebly 
traceable. 

Zone of uncom- 
mon ellipticity on 
left eye ; right eye 
" out." 

Slight arc on 
lower segment of 
both corneas. 

Well-defined arc 
on laiver border of 
both corneas. 



Printer in early life, now publisher ; | 
temperate in habits ; health very good ; 
has no embarrassment of the action of 
heart or lungs ; has never suffered from 
inflammation of the eyes. 

Easy in circumstances ; habits tem- 
perate ; corpulent ; subject to fits of pal- 
pitation of heart, with " short breath ;" 
pulse irregular ; has never suffered from 
inflammation of eyes. 

Slave, but well treated ; common field 
hand ; under treatment for phthisis of 
two months' standing ; action of heart 
undisturbed ; has never suffered from 
" sore eyes." 

Superannuated slave ; health good 
except paralysis agitans; no embarrass- 
ment of action of heart or lungs ; eyes 
good for her age. 

Common labourer; has been well 
treated : health very good ; no palpita- 
tion of heart or disturbed respiration ; 
eyesight good; has never suffered from 
inflamed eyes. 

Circumstances easy ; temperate ha- 
bits ; general health good ; no embar- 
rassment of action of heart or lungs ; 
neuralgic pains of lower extremities ; 
has never had inflammation of eyes. 

Stone-mason ; health very good ; has 
generally been healthy ; habits tem- 
perate ; has no embarrassment of action 
of heart or lungs ; has never suffered 
from inflammation of eyes. 

Circumstances easy ; temperate ; 
health very good ; stout frame ; no de- 
rangement of action of heart or lungs ; 
eyes have never been inflamed. 

Circumstances easy ; rather delicate 
frame ; health generally good ; suffers 
hysterical attacks, with palpitation of 
heart ; respiration at ail times easy ; 
never had inflammation of eyes. 

Circumstances easy; remarkably stout, 
and quite healthy ; action of heart and 
lungs healthy ; right eye lost from severe 
inflammation, left has never been in- 
flamed. 

Practitioner of medicine ; health un- 
sound ; deranged digestion ; no embar- 
rassment of action of heart or lungs ; 
has never had inflammation of eyes. 

Stout frame ; takes much exercise ; 
very healthy ; temperate habits ; no pal- 
pitation of heart or embarrassment of 
respiration ; has never suffered from in- 
flammation of eyes. 



No. XLIX.— Jan. 1853. 



S 



110 Jeffries, Account of last Illness of Daniel Webster. [Jan. 



Art. VII. — An Account of the last Illness of the late Honourable Daniel 
Webster, Secretary of State: icith a Description of the Post-mortem 
Appearances, &c. By John Jeffries, M. D-* 

Mr. Webster was of a sanguineo-bilious temperament, of a swarthy com- 
plexion, with straight black hair, with a large, athletic, and well-proportioned 
frame. He was five feet ten inches in height, and when in health weighed 
one hundred and ninety pounds. His appearance was peculiarly imposing, 
and the expression of his features, more particularly of his eye, was, perhaps, 
more powerful than that of any other man. He was nearly seventy-one 
years of age at the time of his death. 

Mr. Webster, although endowed with an iron constitution, had been subject 
for the past eighteen or tvcenty years to an habitual diarrhoza, which, commenc- 
ing as an occasional looseness, had gradually increased upon him until for the 
last three years it was persistent ; for this, he was accustomed, latterly, to 
use opiates generally in the form of a w cholera medicine," which appeared to 
be composed of sulphate of morphia and the compound spirits of sulphuric 
ether. 

For about the same number of years he had been annually subject to a 
somewhat severe form of catarrh, commencing from the 6th to the 16th of 
August, and continuing until about the 1st of October. The only exception 
to the occurrence of this was in 1839, when he was in Europe. He was 
sometimes confined by this for a short period, but usually continued his ex- 
ercise and duties abroad. In the early years of this complaint, he did but 
little for it; but, latterly, he had adopted energetic treatment under medical 
advice, in the hope of preventing the annual visitation. 

In August, 1851, while at Franklin, N. H., whither he had gone for re- 
tirement, hoping, by a change of climate to escape his annual catarrh, he was 
attacked, after exposure to the damp ground, with gout in his feet, mostly in 
the great toes; he was so far relieved of this, however, as to take a journey 
to the White Mountains ; but, on his return to Franklin, the gout returned 
in a more severe and general form. 

On the 9th of September, he came to Boston and placed himself under the 
writer's care. At this time, his complexion was sallow, and he had lost con- 
siderable flesh ; his eyes were red, and his countenance indicative of great 
uneasiness; his pulse was full, quick, and firm; his nights were distressing 
and restless; there was constant thirst; the bowels were irritable, and, al- 
though without appetite, he was taking food without restraint, and, by advice, 
using stimulating drinks freely. He was also taking iodide of iron with 

. * The author is indebted to Dr. S. Parkuian, for the arrangement of this paper 
from the notes read before the Suffolk District Medical Society. 



1853.] Jeffries, Account of last Illness of Daniel Webster. Ill 

hydriodate of potass, and minute doses of oxide of arsenic as a preventive of 
the catarrh. He had also used some remedies for the gout, and frequently 
resorted to opiates for his diarrhoea. With some difficulty he was induced to 
relinquish all these medicines, to restrict himself to the simplest food, and to 
retire to Marshfield for recreation and exercise. In September, he returned 
to Washington, expressing himself as being " perfectly well," having impli- 
citly followed the directions given. During the winter of 1851 and 1852, he 
transacted a vast amount of business at the seat of government ; being, how- 
ever, frequently under medical treatment for his diarrhoea. He failed in flesh 
and strength towards the spring ; and, in the latter part of April, went to 
Marshfield in hopes of recruiting. 

On the 6th of May, 1852, he was thrown from his wagon, falling forward 
upon his hands, and striking his head with much force upon the ground. He 
was for some time insensible, but soon recovered perfect consciousness. On 
the 20th he came to Boston, and was visited by Dr. J. Mason Warren in 
consultation. He was found to have injured the joints, of both wrists, the 
left more severely, without any apparent displacement or fracture; there was 
considerable swelling and great ecchymosis of the whole forearm, with fre- 
quent severe paroxysms of pain through the joint; there was also a slight 
flesh wound near the right temple. He made no complaint of uneasiness in 
the head. On the 24th May, he addressed his fellow-citizens in Faneuil 
Hall, being then suffering under great general debility. In July, at the time 
of his public reception in Boston, he was suffering more than usual from his 
diarrhoea, and was under medical treatment to enable him to go through the 
fatigues of that occasion. 

On his return from Washington to Marshfield, in September, he took cold 
in Baltimore, and first complained of the symptoms connected with his final 
illness. On the 20th of September, he drove from Marshfield to Boston, a 
distance of thirty miles, for medical advice. 

It was then observed that he had lost much flesh, which gave to his large 
eye a somewhat unnatural prominence. His face was pale with a peculiar 
sallowness; but there was no jaundice at this or any other time. He rose 
from the recumbent posture slowly and with some apparent difficulty, and he 
had the aspect of a very sick man. He stated that he had been more than 
usually unwell for a week or more ; he complained of uneasiness on the left 
side of the abdomen, with consequent difficulty of lying on that side; there 
was also sometimes a sense of tightness across the lower part of the abdomen. 
The bowels were still loose, but not quite so irritable; the appetite was 
wholly gone ; the skin was commonly very dry, and there was a constant 
dryness of the tongue and fauces, with much thirst. The tongue was covered 
with a light brown coat; the pulse was 106, quite full, but easily compressed, 
somewhat jerking, with four intermissions in a minute. The urine was 
scanty, high-coloured, and very turbid after standing, not coagulating by heat. 
The abdomen was much distended and resonant from flatus at almost every 



112 Jeffries, Account of last Illness of Daniel Webster. [Jan. 

part, but particularly at the arch of the colon ; there was flatness in the hypo- 
gastric and iliac regions, and signs of dropsical effusion were thought to be 
perceived. The edge of the liver, more distinctly felt than at any subse- 
quent period, was firmer than natural, but without tenderness on pressure. 
Neither was there soreness at any part of the abdomen. The i'eet and legs 
were cedematous, considerably so about the ankles. There was some sore- 
ness of the soles, especially under the ball of the great toe. There was a 
similar soreness in the left thumb and wrist which had been most injured by 
the accident. He had also flying pains about his lower limbs and body, de- 
scribed as similar to those previously experienced from the gout. The usual 
course of action of the bowels was a dejection at five or six P. M. ; another at 
nine, and a third at from two to four A.M.; these, especially the last, were 
urgent, loose, and with much flatus. After the morning dejection, he took a 
portion of his usual " cholera medicine," which gave him relief. 

He returned to Marshfield the next day, the 21st, with the following direc- 
tions: To abstain from all mental labour, and to avoid fatigue in bodily 
exercise. The diet to be tea with bread and butter, morning and evening, 
and a little animal food at dinner, with one vegetable. 

To take two drachms of castor-oil, and an equal quantity of lemon-juice, every 
second or third day, if troubled by distension, or if the bowels did not act 
kindly. To take a cardiac mixture twice daily, and a pill of one grain of 
acetous extract of colchicum with two grains of camphor each night. 

To have the abdomen gently rubbed, and a hot alkaline bath applied night 
and morning ; the feet and legs, after being smeared with olive oil, to be 
rubbed with warm spirit twice daily. 

On the 28th, 29th, and 30th he was visited at Marshfield, and was found 
with much the same symptoms, except that the abdomen was more tense and 
flat, and there was well-marked fluctuation, with some soreness of the left 
side, for which five leeches were applied with relief. The urine was a little less 
scanty and turbid. He had continued to come down stairs, and one day had 
driven for four hours with visitors ; but this had increased the difficulty of the 
bowels, and much fatigued him. He had had a little headache in the latter 
part of each afternoon ; and he also spoke of a feeling of sinking and exhaus- 
tion, which came on about two o'clock each day. 

On leaving him on the 30th, he was advised to substitute one-sixteenth of 
a grain of morphia for the " cholera medicine ;" to have the abdomen embro- 
cated with spirits of turpentine, diluted with common spirit; to take a pill of 
four grs. compound extract of colocynth, if the bowels required more action; to 
have eight or ten leeches applied to the right hypochondrium, if the bowels were 
more uneasy, and to take two teaspoonsful of brandy, with water, at 2 P. M. 
each day, if he felt exhausted. 

During the writer's absence, he was attended by Dr. John Porter, of Marsh- 
field, from whom frequent reports of his condition were received. 

On the 6th of October, he was visited in consultation with Dr. J ames J ack- 



1853.] Jeffries, Account of last Illness of Daniel Webster. 113 

son, of Boston. The symptoms continued much the same. Mr. Webster 
was about the house, though he had not been out. The opinion was expressed 
and concurred in, that there was ascites, dependent upon grave disease of 
some abdominal organ, which would ultimately prove fatal; although some 
relief might be obtained. 

It was decided to substitute a mild tonic for the cardiac mixture ; to give 
one grain of squills night and morning, to be increased if the stomach could 
bear it; to continue the morphia; and to double the amount of brandy; 
encouraging him also to take a little animal food. 

The symptoms continued much the same until the morning of the 11th, 
when, on coming down stairs for a drive, he became faint, with nausea and 
retching, vomiting a little mucus. Visited at 7 P.M.; he complained of extreme 
distress at the prsecordia, for which he was urgent to have relief; the nausea 
had subsided. A teaspoonful of castor-oil, with one-sixteenth of a grain of 
morphia, was directed, by which the pain was relieved, and an evacuation 
obtained about 2 A. M., consisting of much fecal matter, with very dark bile 
and gelatinous mucus. All medicines but morphia were omitted; castor-oil 
being directed to be used if the precordial distress should return. An an- 
noying symptom, consisting of pains about the feet, of which he had pre- 
viously complained, was noticed to increase in severity from this time. He 
continued tolerably comfortable, and able to come down stairs every day; and 
sometimes to transact considerable business. He was feeble and emaciated, 
but his spirits were buoyant. Throughout his sickness it was noticed that he 
did not bend his body forward in rising, but was raised with the body erect ; 
and more than once, upon being assisted to walk, he had said that he felt as 
if he should fall forwards. 

On the 19th, there was a manifest falling off; he had several copious de- 
jections, which were thought to contain some blood, and he had also two turns 
of retching; by these he was much enfeebled. 

On the 21st, at 5 A. M., the dejection consisted of a large quantity of 
fecal matter, with much bilious and bloody fluid. At 7 A. M. he had another 
similar dejection, with bilious vomiting. Nausea and retching now became 
prominent symptoms, and he became more and more feeble, until at 5 P. M., 
on the 22d, he vomited about a pint of fluid blood with some coagula. Dur- 
ing the night the vomiting became more urgent, always with blood ; and at 2 J 
A. M. he had a copious ejection of fluid blood. By all this he was much 
exhausted. The vomiting of blood continued very profusely; and whenever 
he attempted to speak, he was interrupted by hiccough or retching. 

On the morning of the 23d he announced himself conscious of his situation, 
and said, " I. shall die to-night." From 9 until lj P. M. he remained free 
from vomiting. He was at this time visited by Dr. James Jackson, who had 
frequently been consulted during the progress of the disease. The vomiting of 
blood recurred during the afternoon. Dr. J. Mason Warren arrived towards 
night, and remained until the patient's death. Mr. Webster continued thus 



114 Jeffries, Account of last Illness of Daniel Webster. [Jan. 

gradually sinking from the loss of blood by vomiting, retaining the power of 
utterance until midnight, and some evidence of consciousness until 1 A. M., 
and sinking gradually, without convulsion, cold sweat, or haze of the eye, ex- 
pired at thirty-five minutes past two on the morning of Sunday, October 24. 

For the last two days he was supported by such stimulants as he could 
bear, and was quieted by opiates when required. 

The autopsy was made by Dr. J. B. S. Jackson, who furnishes the follow- 
ing report : — 

Autopsy thirty-two hours after death; present Drs. Jeffries, Porter, J. 
Mason Warren, Wyman, Parkman, and Jackson. 

The emaciation was very marked, as shown by the state of the integuments 
and muscles; the latter being wasted, pale, and flabby. 

Abdomen. — The peritoneal cavity contained eleven pints of serum. There 
were also old and strong adhesions about the spleen, the gall-bladder, the 
caecum, and to a small extent between the left extremities of the arch of the 
colon and the parietes of the abdomen. 

The stomach was distended, and contained half a pint of very dark blood, 
about one half of which was in the state of a soft coagulum ; and this was the 
only appearance that was found of coagulum in any part of the body. The 
mucous membrane was deeply stained by the contents, generally rather soft, 
and in the pyloric portion somewhat mamellonated. The intestines were 
opened throughout, washed, and fully examined with reference to the diarrhoea 
that had so long existed. Blood was found throughout in very considerable 
quantity as far as the descending colon, below which there was no trace of it ; 
in the large intestine it was altered as usual in colour. Mucous membrane 
stained by the contents so far as blood extended. "In the larga intestine were 
numerous hernise of the mucous membrane, so common in this situation; 
from many of these small masses of feces or of mucus could be forced out, 
and these were the only traces of feces that were found. Otherwise, the mucous 
membrane of the intestines appeared quite healthy ; there being nowhere any 
ulceration to explain the diarrhoea, nor ecchymosis connected with the hemor- 
rhage. 

The liver was, throughout, very markedly granulated; dense, and con- 
tracted in size ; the colour externally was greenish or bronzed, but internally 
everywhere of a pale red; showing, as we may not very unfrequently observe, 
the inappropriateness of the term " cirrhosis/' which would generally have 
been applied to the present case. Weight of the organ, three pounds and one- 
third, avoirdupois. Bile in the gall-bladder nearly black, and of a tarry con- 
sistence. 

Spleen small, pale, and shrivelled. Investing membrane to some extent 
opaque, white, thickened, and condensed; this change being probably due to 
the old peritoneal affection. 

Kidneys and pelvic organs healthy. 



1853.] J effries, Account of 'last Illness of Daniel Webster. 115 

Thorax. — Old pleural adhesions over nearly the whole of the right side; 
none on the left. Lower lobe of the left lung and the two lower lobes of the 
right much congested, and very dark; a change that undoubtedly occurred 
towards the close of life, being simply passive. 

Heart flaccid; very little blood in cavities, and this was quite liquid. Slight 
disease of aortal valves, but organ otherwise healthy. Foramen ovale; a 
small valvular opening existed. Aorta not ossified, except to a small extent 
in the abdomen. 

Mead. — The membranes of the brain were most remarkably diseased. In 
the cavity of the arachnoid was a layer of fibrine which covered almost entirely 
and about equally the convexity of both hemispheres; it did not extend, 
however, beneath nor between them, nor about the cerebellum. In the 
recent state, it had a rather dull, yellowish, infiltrated, oedematous appear- 
ance ; being one-fourth of an inch in thickness over the upper surface, but 
becoming gradually more thin on the sides, where it terminated in a thin 
edge. The adhesion to the dura mater was in some parts quite close ; but it 
was generally very readily stripped off, and left the arachnoid with its usual 
polish. It was more adherent to the subjacent membrane ; this last being 
irregular, and having generally a clouded and slightly opaque appearance, with 
many milk-white spots, but without any appreciable thickening. The quantity 
of serous effusion into the membranes was altogether large. The subarach- 
noid tissue corresponding to the layer of fibrine above described was infiltrated 
with a straw-coloured serum in some places, separating the convolutions from 
each other; this separation was quite remarkable at the posterior part of the 
right cerebral hemisphere on its upper surface and near the median line, 
there being also a slight depression at this part. The dura mater adhered 
firmly to the calvaria, but was healthy in structure, as were the membranes 
otherwise ; there was, however, a serous infiltration into each plexus choroides ; 
though no more, if not less than usual, into the lateral ventricles. No appear- 
ance of recent meningitis ; and no effused blood or cysts in or about the false 
membrane. The brain itself was perfectly healthy ; and the arteries at the 
base very nearly so. Cranium healthy. Over the right frontal region a scar 
existed, the result of the injury that occurred last May; integuments not 
otherwise remarkable. 

A portion of the fibrine from the arachnoid cavity having been removed for 
microscopical examination, it was found, some hours afterwards, and when the 
serum with which it had been infiltrated was absorbed, to have almost the 
consistence of one of the natural tissues of the body ; being strong enough to 
bear considerable traction ; it also appeared then to have somewhat of a lami- 
nated structure, and bloodvessels were distinctly seen in it even with the 
naked eye. Dr. Wyman found it " organized, and, in some places vascular. 
Under the microscope, the lymph was resolved into minute fibres, like those 



116 Jeffries, Account of last Illness of Daniel Webster. [Jan. 

forming the white fibrous element of areolar tissue, and including in their 
meshes large numbers of minute granules." 

Recapitulating the points of interest in this case, it will be observed that 
the immediate cause of death was hemorrhage from the stomach and bowels. 
For this, no source could be found in the lesion of any vessel ; it must there- 
fore be regarded as a simple exhalation dependent upon a disorganization of 
this fluid, indicated, moreover, by the almost entire absence of coagulation. 
The relation of this hemorrhage to the disease of the liver will also be noted 
as coinciding with previous experience; it being well known that, in certain 
cases where there is an altered action of this organ, there is a tendency to 
disorganization of the blood, manifesting itself thus in hemorrhage. 

The morbid appearances observed in the cerebral membranes possess, also, 
very great interest in several aspects. It will be unnecessary to dwell upon 
the particular appearances carefully described above. A very full and clear 
description of these interesting forms of extravasation has been published by 
Mr. Prescott Hewitt, in the twenty-eighth vol. Medico- Chirurgical Transac- 
tions of London, and the appearances, in this case, coincide with those there 
described. Grisolle (Pathologie Interne, vol. i.) has also well described this 
affection, after the original descriptions of Serres, Baillarger, Boudet, and 
Prus, who were the first to call attention to this particular lesion. The case 
of Mr. Webster may be regarded as unique, however, in this respect, that no 
impairment of the power of the nervous system was observed before death; 
for although a few symptoms, such as his mode of locomotion, his sense of 
falling, and a slight hesitation of his speech, may now be remembered and 
connected with this condition, it will be sufficient to prove the entire absence 
of any suspicions of the kind during life, to state that the brain would not 
have been examined at the autopsy, except for the desire of making the 
measurements, &c, recorded below. The connection of this meningeal hemor- 
rhage with the cirrhus of the liver will also give rise to interesting specula- 
tion; for although it is quite probable that the origin of the effusion should 
be ascribed to the accident in May, still, it is not unlikely to be remotely 
dependent upon the disorganization of the blood consequent upon the disease 
of the liver, since among Mr. Hewitt's cases there are some recorded where 
an effusion quite equal to this took place in connection with a cirrhus without 
any injury at all. It is possible, moreover, that the accident may not have 
been the cause of the effusion, which may have taken place since that time; 
but, in the presence of what would appear an adequate cause, it will be unne- 
cessary to look beyond. 

In the treatment of the disease, attention was particularly directed to the 
duodenal obstruction, relief from which was obtained by the laxatives occa- 
sionally administered, and these, with opiates, were almost the only important 
medical agents. 

The following very interesting account of the cranial cavity and brain is 
furnished by Dr. Jeffries Wyman : — 



1853.] 



Jeffries, Account of last Illness of Daniel Webster. 



117 



The dimensions of the brain, as indicated by the measurements of the cra- 



nial cavity,* were as follows : — 

Longitudinal diameter . . . . 7} inches. 

Transverse " ..... 5| a 

Vertical / " - . . .. . . 5f " 

Breadth of occipital fossa . . . . . 4f " 

" frontal " . . . : . 5 " 



The posterior clinoid processes were seven-eighths of an inch in front of 
the centre of the cranial cavity. 

The circumference of the head was 23f inches, and the distance from the 
meatus of one ear to that of the other, over the top of the head, was 15 
inches. 

The capacity of the cranium, determined according to the method adopted 
by the late Dr. S. Gr. Morton, of Philadelphia, was 122 (one hundred and 
twenty-two) cubic inches. 

The substance of the brain was firm to the touch, and, as regards colour 
and consistence, appeared to be healthy. The depth of the spaces between 
the convolutions was, on the vertex seven-eighths of an inch, and the " corti- 
cal" or gray substance was three-sixteenths of an inch in thickness. 

The corpus callosum, or the great cerebral commissure was large, mea- 
sured four inches in length from before backwards, and at the central portion 
was one-fourth of an inch in thickness. 

The pineal body, as in the great majority of instances, contained calcareous 
concretions. 

The weight of the brain, including the cerebrum, cerebellum, and medulla 
oblongata, as far as the lower extremity of the pyramids was (in avoirdu- 
pois) : — 

Lbs. Oz. Drachms. Grs. Grains. 
Brain (encephalon)f .3 5 8 17.75=23,424.0 
Cerebrum ... 2 14 7 14.09=20,330.5 

The measurements which have been given above, are almost without excep- 
tion of unusual proportions. The average length of the cranial cavity does 
not exceed six and a half inches; its transverse diameter is five inches, and 
the vertical a little less. J 

* In consequence of its flaccidity, the natural diameters of cerebral substance are 
no longer preserved after the brain is removed from the cranial cavity ; its diameters 
are, therefore, more correctly measured by determining those of the cavity which it 
filled. 

■f In Troy weight, the result was as follows : — 

Pounds. Ounces. Pennyweights. 

Brain . . / 4 ' 16 

Cerebrum . ... 3 6 6 

J Dr. Morton gives the average diameters for European and Anglo-American skulls 
as follows ; Longitudinal, 6$ ; transverse, 5J, and vertical, 5 inches ; these measure- 



118 



Jeffries, Account of last Illness of Daniel Webster. 



[Jan. 



The cranial capacity was very unusual, the largest which has yet been re- 
corded, though measurements in cubic inches have, as yet, been made by 
comparatively few observers. In Dr. Morton's Tables of the measurements 
of 623 crania of different nations, including Caucasians, Mongolians, Malays, 
Americans, and Negroes, only four instances occur in which the capacity ex- 
ceeded one hundred cubic inches; of these the largest were one English skull, 
measuring 105, and one German 114 cubic inches. According to Dr. Morton, 
the average capacity for the Teutonic family (including English, Germans, 
and Anglo-Americans) is 92 inches.* 

The two superficial measurements of the head were very nearly those of 
Cuvier, the circumference of whose head was 22 inches 4 lines (French), and 
the measurement from ear to ear over the top was 15 inches. The circum- 
ference of Napoleon's head is reported to have been 23 inches. 

The weight of the brain deviated much less from the average than the 
measurements; it was entirely out of proportion to the unusual dimensions 
of the cranial cavity. The average weight of an adult healthy male brain is 
49 \ ounces, or 3 pounds \\ ounces avoirdupois.f As has been already 
stated, there existed an effusion of serum into the subarachnoid areolar tissue, 
and of serum and lymph into the arachnoid cavity. The lymph had existed 
for a long time, it covered the convex surface of the cerebral lubes, was a 
quarter of an inch in its thickest portion, and extended to the sides, where 
it became quite thin. Both serum and lymph, there can be no doubt, en- 
croached upon and occupied the space once filled with cerebral substance. 
The weight given above, therefore, cannot be regarded as being equal to the 
weight of the brain in a state of health. This last we now have no means 
of determining except by an approximation, which has been made in the 
following manner, in accordance with a suggestion by Professor Tread well, 
of Cambridge. 

ments, however, are external, and include the thickness of the skull, and would, there- 
fore, be too large, by the thickness of the cranial walls, to represent the size of the 
brain. Human Anatomy, p. 70 : Philadelphia, 1849. 

Cruveilhier, following Bichat, makes them somewhat less than those given in the 
text ; his mode of measurement, however, does not give the greatest dimensions of the 
cranial cavity. See his Traite oVAnat. de V Homme, t. i. p. 140. Paris, 1843. 

* Catalogue of Skulls of Man and the inferior Animals in the Collection of Samuel 
Geoi'ge Morton, M. D., Philadelphia, 1849. See Comparative Table on page viii., and 
Specimen No. 434. 

Dr. J. B. S. Jackson, in the Descriptive Catalogue of the Anatomical Museum of the 
Boston Society for Medical Improvement, has given the measurements of thirty skulls 
of different nations, the largest of which, a Theban and a Negro, were 95 inches each. 
Of ten Hindoo skulls, measured by Dr. S. Kneeland, Jr., the largest, that of a Bajah, 
contains 92 inches. Proceedings of Boston Soc. Nat. Hist., vol. iii. p. 213. 

| This is the result of observations on two hundred and seventy-eight adult healthy 
male brains. See Sharpey's Quain's Anatomy, Dr. Leidy's edition, vol. ii. p. 186. 
This determination is based on the combined observations of Reid, Sims, Tiedemann, 
and Clendinning, which are all reduced to avoirdupois weights. 



1853.] 



Jeffries, Account of last Illness of Daniel Webster. 



119 



The specific gravity of the brain is, according to Cruveilhier and others, 
1030, water being 1000. A cubic inch of water weighs 252.5 grains, and 
122 cubic inches (the cranial capacity), would equal 30,805 grains, to which 
must be added 3 per cent., or 924 grains (the excess of specific weight of 
brain over water), which gives 31,829 grains as the full capacity of the cranial 
cavity in weight for cerebral substance. The brain, however, does not actu- 
ally fill the whole cavity ; a correction must, therefore, be made for the spaces 
occupied by the tentorium, falx, sinuses, the dura mater of the calvaria, and 
the cephalo-spinal fluid at the base of the brain. If we deduct eight ounces 
for such spaces, we shall have an actual weight of 28,329 grains; or, if nine 
ounces are deducted, 27,891 grains. Taking the last approximation as the 
one the least liable to error of excess, Mr. Webster's brain will be found to 
rank among those whose brains are generally cited as instances of remarkable 
size, as follows : — 





Lbs. 


Ozs. 


Drs. 


Grs. 


Grs. 


Ozs. 


Cuvier* 


4' . 





5 


10 


= 28,147 


= 64^ 


Webster 


3 


15 


12 





= 27,891 


== 63f 


Abercrombief 


-8 


15 








= 27,562 


= 63 


SpurzheimJ 


a 


7 


1 





= 24,089 


= 55ft 


Dupuytren§ 


3 


1 


10 


27 


= 21,738 


= m 



The brains, the weights of which (in avoirdupois) are included in this table, 
are not the only ones on record remarkable for size. In the table of Dr. Shar- 
pey, already quoted, there are enumerated as weighing between 55 and 59 
ounces, avoirdupois, inclusive, 28 brains ; and between 60 and 65 ounces, 7.|| 

* In the official report of Cuvier' s post-mortem examination, the weight of the brain 
is given as 3 livres, 11 onces, 4.5 gros, poids de marc, or old French weight; this, 
reduced to avoirdupois, gives the weight in the above table. It has, however, been 
differently stated by physiological writers. Tiedemann reports it at 3 lbs. 11 ozs. 
4 drs. 40 grs. avoirdupois. (Memoir on the Brain of the Negro, Philos. Trans. 
1836, p. 502.) This erroneous computation has been often repeated ; and is the one 
given in the Cyclop. Anat. and Physiology, Art. Nervous System, p. 664, and in other 
works. It is correctly stated in Sharpey's Quain's Anatomy. 

f Quoted from Sharpey's Quain's Anat. vol. ii. p. 187. 

J Anatomical Report on the Skull of Spurzheim, read April 2, 1835, before the 
Phrenological Society of Boston, by N. B. Shurtleff, M. D. Annals of Phrenology, vol. 
ii. p. 72: Boston, 1835. 

\ Dupuytren's brain was really not remarkable for size, being only two drachms 
above average ; it is generally erroneously reported at 4 lbs. 10 ozs. Troy. An 
official report, signed by Broussais, Cruveilhier, Husson, and Bouillaud, which may 
be found in the Revue Medicate, 1835, states it to have weighed only 2 livres, 14 onces, 
poids de marc. This, reduced to avoirdupois, is equal to the amount given in the table. 

|| In estimating brains by weight, it must be borne in mind that quantity and not 
quality is considered ; the anatomist has no means of determining quality. The head 
of Byron may be cited as an instance where small size was associated with great 
activity. Lord Napier informs us, that of fourteen persons who dined with him on 



120 Brown, Case of Extensive Disease of Cervical Vertebrae. [Jan. 

Nothing is said of the individuals from whom they were taken ; of the two 
largest, one weighed 63 and the other 65 ounces ) it is not improbable that 
these were the brains of Abercrombie and Cuvier ; 63 ounces being precisely 
the weight of the former. In making out the table, all instances with frac- 
tional parts were classed with the next integral number; and, as Cuvier' s brain 
weighed over 64 ounces, it would rank as 65 ounces. If this be not the expla- 
nation, then there is on record a larger healthy brain than that of Cuvier. 



Art. VIII. — Report of a Case of Extensive Disease of the Cervical Vertebrae, 
with Remarks on this and some other forms of Carious Disease of the 
Spine. By Buckminster Brown, M. D., of Boston. 

Scrofulous disease of the spine, terminating in caries, is a frequent as 
well as one of the most inveterate forms in which this constitutional taint 
presents itself to our notice. It often commences without any external 
exciting cause, and is as often traced by the patient or his friends — who are 
actuated by the desire, so inherent in the human mind, to find for every 
result an evident cause — to some injury slight or severe. 

Angular curvature, however, may, without exception, be attributed to an 
original or acquired feebleness of the recuperative powers of the system, and 
is generally attended by other of the distinguishing and characteristic insignia 
of the strumous diathesis. 

Undoubtedly a blow or fall, which in a healthy subject would occasion but 
trifling and temporary inconvenience, may in certain instances produce a low 
degree of subacute inflammation in the spine, or elsewhere, sufficient to arouse 
that slumbering hereditary predisposition, which, lying dormant, is ready, on 
the slightest excitement, to spring into action. 

It is, however, but the spark applied to a storehouse, hastening the explo- 
sion which would, sooner or later, have spontaneously taken place from the 
chemical action insensibly going on among its own materials. 

The bones of the spine and of the hip-joint are the parts most frequently 

one occasion, not one could wear Byron's hat. Napier's servant, "who had the smallest 
head in the 90th Regiment, so small that he required to have his caps made expressly 
for him, tried on Byron's hat and found that it just fitted him. See Moore's Life of 
Byron. In Br. Bruno's report of the autopsy of Byron, his brain is said to have 
weighed "six pounds (mediche)." See Count Gamba's Narrative of Byron's last 
Journey to Greece, p. 271, London, 1825. This must be an error, if the pounds are 
those of apothecaries' weight. The above anecdote shows that his head was not large. 
Thorwalsden's bust does not give it unusual elevation ; and Moore states that it was 
"disproportionately small." His habit of shaving off his hair gave it an appearance 
of elevation. 



1853.] Brown, Case of Extensive Disease of Cervical Yeriehrse. 121 



affected by caries, and, when the disease proceeds unchecked by treatment, 
suffer the most severely from its devastations. Of this elective tendency, we 
have ample proof in the numerous pathological specimens of carious spine and 
hip to be met with in every cabinet of any size either in Europe or America ; 
and, independent of this svidence, private experience sufficiently evinces that 
such is the fact. 

An example of disease of the vertebras so extensive in its effects as the 
following, both as regards the bony structures destroyed or removed, and the 
implication of parts so essential to vitality as the upper portion of the spinal 
nerve, even impinging on the locality, so to speak, of life itself (the respiratory 
tract of Bell) is of most rare occurrence, and perhaps has never before been 
met with. 

The patient, George Burr, a mulatto, was 27 years of age. His stature 
was short, bones small. In February and March, 1851, he was treated 
for what his friends believed to be rheumatism. He had severe pain in 
the back of his neck, between his shoulders, in his arms, and shooting through 
his chest. While under treatment, a puffy swelling made its appearance 
between the scapulae. This swelling disappeared in a few weeks. The 
latter part of March, while on his way from Boston to Plymouth, an 
accident happened to the cars a short distance from the city, by which 
he was thrown into the water, but sustained no other injury. He ap- 
peared to suffer no immediate inconvenience from this exposure further than 
a severe chill, which came on after his long walk back to the city in drenched 
clothes, the day being cold and stormy. The latter part of the summer, which 
was passed in Plymouth, he frequently complained of a feeling of numbness in 
his lower limbs. In October, he had a severe attack of epistaxis, which threat- 
ened life, and by which he was much debilitated. The latter part of October 
he returned to Boston. At this time there was a swelling on the back of his 
neck extending from the occipital bone to the fifth or sixth cervical vertebra. 
The jar of the cars produced much distress, and he was obliged constantly to 
steady his head with his hands during the journey. At this period there was 
at times some degree of deafness. 

For some months after his return to Boston, the patient continued in about 
the same situation. I saw him for the first time the latter part of February. 
A fortnight previous, after making a sudden movement to look out of the win- 
dow, he laid down with less caution than usual, resting his head upon the 
arm of the sofa, when he felt a sudden twinge, and heard a crack in his neck, 
at the same time his head was violently twisted towards the left shoulder. 
He was immediately seized with the most intense agony, dyspnoea, general 
convulsions, alternating with rigidity or a cataleptic state of the limbs. He 
remained in this situation some hours, after which he walked across the street 
home, where he had another similar attack. At times, during the night, he 
appeared to be in articulo-mortis, lying perfectly motionless, covered with 
large drops of cold perspiration. Towards morning there was some improve- 
ment in his symptoms. 

When first seen by me, the head was, as above described, strongly rotated 
to the left; the swelling in the neck had partially disappeared ; there was 
total inability to move his head independently of his body, and it was drawn 
somewhat backward, as well as to the side, All the muscles of the cervix 
were rigidly contracted, and in every motion the consentaneous and instinctive 



122 Brown, Case of Extensive Disease of Cervical Vertebrae. [Jan. 



energy of the whole body seemed to have but one object, that of keeping the 
head steadily in its place. 

The usual diagnostic marks of carious vertebrae were not present. There 
was no angular projection of one or more of the spinous processes, and more 
especially there was no anterior or lateral drop of the head, pathognomonic of 
disease of the cervical vertebrae, particularly of the superior, and, also, there 
was wanting that peculiar sinking of the head between the shoulders, which I 
have learned to consider as characteristic of caries of the inferior. And there 
was as yet no paralysis. 

On more minute examination, however, of the spine in this region, I found 
a remarkable condition of the vertebrae. One of the spinous processes had 
disappeared from its normal position, and at the upper part of the neck, the 
finger sunk into an excavation in which it could be laid flatwise, without any 
more than filling the space. On examining the pharynx, a projection or ful- 
ness was observed at the back part, on a level with the third or fourth cervical 
vertebra. A slight degree of soreness of the throat was complained of. I 
stated my opinion that there was luxation of the cervical vertebrae at the 
point indicated j the result of caries. 

In the course of a week from this time paralysis supervened. It com- 
menced in his arms, and extended until voluntary power over every muscle in 
the body was destroyed, with the exception of those about the mouth and 
eyes, which were only partially affected. 

The muscles of the lower extremities still possessed a firmness and tone 
very different from the flabby, lax condition observed in paralysis from dis- 
ease of the lower portion of the spinal cord. This evinced a continuance of 
reflex power below the seat of the disease, and that the property, inherent to 
the nerve, of maintaining the contractility of the muscles paralyzed to the 
influence of the will, was undiminished. On the contrary, and in confirma- 
tion of the observations of Dr. M. Hall and others, the power referred to was 
in this case and others which have fallen under my observation increased, so 
as to produce a remarkable degree of rigidity. The muscles about the neck 
and arms were totally deficient in firmness or tone, and hung like those of a 
corpse. Sensation below the disease was lessened, but not annihilated. The 
arms, hands, legs, and feet were very cold to the touch, although the patient 
thought them comfortably warm, and sometimes he felt in them a burning 
heat. His pulse was 100, and his respiration 17 or 18 per minute. In 
respiration, there was no motion of the abdominal muscles. It was entirely 
thoracic. Probably maintained chiefly, if not entirely, through the par 
vagum. and perhaps the sympathetic, by means of the filaments which this 
nerve derives from the cerebro-spinal system. 

The emaciation was extreme; appetite good; deglutition not materially 
impaired; bowels costive; and he had a slight cough. His mind was clear, 
and his countenance not anxious. 

For the two or three succeeding weeks the patient was in the hands of an 
Indian, or botanic doctor. When I again saw him, his situation had not 
varied much from that above described. The cough had increased, and he 
expectorated large quantities of bloody muco-purulent matter. The physical 
signs of pulmonary disease were not strongly marked. There was complete 
relaxation of the muscles of the neck; they had not the slightest power over 
the motions of the head, which fell when any attempt was made to move 
him. The sign of dislocation had partially disappeared after the complete 
loss of contractility in these muscles. The least change- of position was 
attended with the most alarming symptoms. The assistance of four persons 



1853.] Brown, Case of Extensive Disease of Cervical Vertebras. 123 



was required when he was turned. One to guide the head, while another 
took the shoulders, etc. Even with all this caution, there was always dysp- 
noea, spasm, cerebral symptoms — as dizziness, etc., aphonia and extreme 
exhaustion. 

He experienced much relief from a spring support that I adapted to his 
neck, which sustained his chin, and bearing on the mastoid process and base 
of the cranium on each side, and on the sternum and clavicle below, effect- 
ually steadied his head. This he wore to the time of his death. Generous 
and somewhat stimulating diet was directed. 

Convulsive movements of the legs were frequently excited by gently 
touching his feet; and he was constantly annoyed by spasm of the different 
muscles, or by "a springing" of the legs without any external cause. 

The patient remained in this state until his death, the immediate exciting 
cause of which appeared to be some mince-pie that was clandestinely pro- 
cured by one of his attendants. His mind was unclouded to the last. He 
died on the 18th of April. There was at no time relaxation of the sphincter. 

Post-mortem. — Body excessively emaciated. No curve or projection of any 
part of the spinal column. On the anterior face of the bodies of the cervical 
vertebrae, the cyst of an old abscess was found. This cyst contained no fluid, 
was about the size of an hen's egg, and through an opening formed by the 
removal of the body of the second vertebra, and which extended from the 
first to the third, it communicated with the rachidian canal between the dura 
mater and the arachnoid. It is probable that the collection of pus existed at 
first external to the membranes, and finally opened through the dura mater 
into its cavity, which accounts for the disappearance of the effused fluid. On 
opening into the upper part of the cyst, towards the medulla oblongata, a loose 
piece of carious bone, the size perhaps of half a filbert, rolled out of the 
medullary cavity. In the course of a careful dissection, another piece much 
larger than the first, also loose and carious on all sides, was found. These 
were the remnants of the odontoid process and of the body of the axis which 
was entirely destroyed or removed, with the exception of a small lamina on 
the left side, that still remained attached to the semicircle of bone. The 
inferior articulating process on the right side was carious. The superior on 
the same side and the transverse with its vertebral foramen destroyed. 
The superior articulating process on the left carious, its articulating cartilage 
and capsular ligament gone, and the caries extended over the lamella towards 
the posterior arch. Ascending to the atlas, the disease had destroyed both 
inferior articulating cartilages and partially the processes, extended anteriorly 
round the condyles, upwards towards the superior condyles, and posteriorly 
through the left lamina of the posterior arch, breaking entirely through it at 
one point, and continuing on until it involved the posterior tubercle. In the 
occipital bone, the right articulating condyle and the basilar process was 
roughened, thinned, or its continuity entirely destroyed. 

The apex of the odontoid was found suspended by its alar ligaments in its 
normal situation. The occipito-axoid ligament which incloses the odontoid 
process was ulcerated through, thus permitting the fragments of this process 
to find their way into the vertebral canal. This process had been twice broken ; 
once from its apex, which had been left adhering by its ligaments to the 
margin of the foramen-magnum, and once at its base, from the body of the 
dentatus, which had likewise separated from the rest of the bone. 

It is evident that one of these fractures must have occurred at the time 
when a crack was heard and felt in the neck, followed by immediate luxation 
and the symptoms previously described. 



124 Brown, Case of Extensive Disease of Cervical Vertebrae. [Jan. 

The anterior face of the body of the third vertebra was also affected with 
caries, and the intervertebral substance almost completely destroyed, together 
with a part of its right articular process, and the whole of its anterior pedicle 
which should have inclosed the vertebral foramen. 

Softening had likewise commenced in the cartilage between the bodies of 
most of the other cervical bones. Some, when in a fresh state, presented fine 
examples of central softening; and others, of well-defined ulcerated perfora- 
tions, illustrative of the earliest stages of the disease when commencing in 
this part. The body of the sixth was deeply corroded, and the transverse 
processes of the seventh somewhat so. There was a remarkable, almost trans- 
lucent thinness of some parts of the os occipitis. 

The medullary substance in the cervical region was softened from the fora- 
men-magnum to the first dorsal. The upper part was reduced to a pultaeeous, 
semi-fluid mass. The medulla oblongata, of its natural consistence and ap- 
pearance. The brain was healthy. Tubercles were found in the lungs, and 
strong, old pleuritic adhesions on both sides. 

It is an extraordinary circumstance that, after the fracture of the dentatus, 
the head should still have maintained its upright position until the occurrence 
of paralysis. This phenomenon can only be accounted for by the dislocation, 
made evident at the time by the injury inflicted on the nervous system, by 
the rotation of the head, and displacement of the spinous process, in conse- 
quence of which the vertebrae were turned in such a way as to support each 
other, and in some measure supply the place of the broken bone. 

It will, perhaps, be interesting to describe the exact position of the parts 
by which this fortunate result, so far as the life of the individual was imme- 
diately concerned, was rendered possible. 

The thin, brittle fragment which still remained of the body of the axis on 
the left, rested on the pedicle of the third vertebra on the same side, ante- 
rior to the vertebral foramen, thus affording support in an upright though 
rotated position; while a rapidly decaying pedicle of the posterior arch on 
the right, which had slipped forward on the inferior articulating process of the 
vertebra above, with its lower edge resting on the body of the third, effectually 
prevented the drop of the head forward. 

The spots specified bear the marks of pressure from the corresponding points 
of bone.* 

That entire loss of power did not immediately follow the accident, is ac- 
counted for by the fact that, although the caliber of the canal was lessened, 
yet it was not directly impinged upon by any sharp edge or point of bone. 

When paralysis did take place, it was a consequence of the extension of 
the disease to the membranes, and through them, thus bringing the purulent 
matter in contact with the spinal nerve, which, at the point indicated, appeared 
to have suffered complete disorganization. That its functions were not wholly 
annihilated is, however, evident. There must have been a portion, the most 
remote from the earliest seat of the disease, viz., of the posterior columns, that 



* The parts described have been carefully preserved. 



1853.] Brown, Case of Extensive Disease of Cervical Vertebrae. 125 

still retained, however imperfectly, the power of conducting to the brain the 
slight degree of sensation which remained in the body below this point. 

It will be found, upon investigation, that the spinal nerve does in reality 
permit of a much greater degree of equable compression, without producing 
immediate paralysis or disorganization, than d priori we should have deemed 
possible. 

If, at the moment of the first occurrence of the displacement, life is not in- 
stantly extinguished, the nerve may become accustomed to the new state of 
things, and fulfil its functions more or less perfectly, according to the amount 
and cause of the accident. 

There are accounts of two remarkable cases reported by G-oetz, of Halle, and 
Wigan, which latter has been cited by Mr. Lawrence, proving the extent to 
which this diminution of the compass of the canal may take place without 
destroying nervous power. In the former, the occipital foramen was diminished 
one-half, without paralysis. 

The case was that of a young man sixteen years of age. He had a gouty 
constitution. The bones of the neck finally became diseased, and his head 
gradually inclined in a lateral direction, so that, in course of time, it fairly 
lay upon the right shoulder, where he was obliged to carry a cushion for his 
head to rest upon. This patient died of apoplexy while walking in the street. 
There was complete anchylosis of the os occipitis with the atlas and odontoid 
process. The first vertebra was displaced anteriorly, and the process of the 
second projected into the foramen-magnum in such a manner as to lessen it 
one-half, producing, of course, great compression of the nervous mass. 

In the case cited by Mr. Lawrence, there existed bony union of the occipital 
bone with the atlas and axis, with displacement of the first vertebra to the 
left, of the second to the right, and projection of the odontoid process into 
the occipital foramen, close upon the right anterior condyloid foramen. The 
subject died of caries of the lumbar vertebrae. 

Sandifort gives a drawing of a case, in which the first and second vertebrae 
were solidly anchylosed together, and with the occiput. Previous to the union, 
a most remarkable displacement of the upper vertebrae had taken place, by 
which two-thirds of the foramen-magnum had been closed. In addition, a 
strong osseous column extended from the jugular process of the temporal bone, 
on each side, down to the transverse process of the atlas, to which it was 
firmly united. This was certainly a most extraordinary provision of nature 
for preserving equilibrium and supplying the place of the dislocated bones. 
These adventitious side-bones were, in fact, two natural splints. 

The history of this case is imperfect. The individual lived a long time 
after the luxation, but we are not informed of the state of the motor or sen- 
tient nerves. The case is, nevertheless, an interesting one, and worthy of 
note in this connection. 

Duverney has likewise described one somewhat similar. The six upper 
vertebrae were united by bone, and there was a luxation so complete as to 
No. XLIX.— Jan. 1853. 9 



126 Brown, Case of Extensive Disease of Cervical Vertebrae. [Jan. 

throw the odontoid process back to within the distance of two lines of the pos- 
terior arch. 

Other writers, as Hunauld, in the Anatomie Chirurgicale, Frank, and 
Meckel, have related instances resembling, in some respects, the preceding. 
These descriptions, however, are not accompanied by any accounts of the symp- 
toms which attended this state of things during life, and therefore can be 
considered simply as scientific curiosities. 

In the more common forms of angular curvature of the spine, the diameter 
of the canal, instead of being decreased is sometimes enlarged, and, in the 
majority of cases, the paralysis, which is so frequent an attendant on this 
disease, cannot be attributed to the alteration in the position of the bones. 
When it does occur, it is probably occasioned by the pressure of the tuber- 
culous and puriform matter which is effused ; or, when this is not confined 
within parietes sufficiently inelastic to produce such an effect, and as an addi- 
tional independent cause, it comes on as a consequence of the disease involv- 
ing the membranes, or the cord itself ; in which case, the paralytic symptoms 
occur in the latter stages. 

When combined with abolition of the voluntary power, we find in the 
muscles not simply the property of tone remaining, but, as is sometimes the 
case, strong contractions, we may with justice conclude that there is present 
some more active exciting cause ; that there is probably some mechanical irri- 
tant, as points or spicula of bone, impinging on the posterior columns of the 
spinal cord. In the case of Burr, which we have given above, the rough 
fragments that were found floating about in the vicinity of the medulla- 
oblongata, at times, if not constantly, lying directly upon it, will account for 
the state of rigid flexion in which the lower limbs were for the most part 
retained. 

It is an interesting object of inquiry in connection with angular disease, 
which of the spinous processes it is that projects, or, when more than one are 
implicated, which is most salient. 

This has been the subject of experimental and pathological investigation 
by various writers. MM. Nichet, Delpech, and Bonnet, have determined 
that it is always the one diseased, or that which has been most affected, which 
forms the angle. 

According to the observations of these gentlemen, the vertebra placed im- 
mediately above tips forward, or "submits in its totality to a forward move- 
ment," by which the spinous process of the diseased bone is left uncovered, 
forming of course a sharp projection. 

This undoubtedly is the fact, as can be satisfactorily ascertained, not only 
by examinations of the diseased parts after death, but also experimentally, 
on the skeleton, by bevelling off anteriorly the bodies of one or two vertebrae 
in a healthy spine, in such a way as to simulate, as nearly as possible, the 
state in which they are most frequently found when affected with caries. 

I will here refer to a circumstance that has, in one or two instances, 



1853.] Brown, Case of Extensive Disease of Cervical Vertebree. 127 



attracted my attention, and which was particularly to be observed in the case 
of young Burr. When relating the case, I stated that there was no pus 
found in the cyst after death. The small amount in the spinal canal, or which 
was at any time effused, when placed in comparison with the extent of the 
disease, is an incident worthy of note. 

Destruction of the vertebras may be the result of three* different forms of 
disease. In the first, there is simply slow absorption without suppuration or 
caries. In the second, there is caries with ulceration and abundant purulent 
or tuberculous deposits; and authors speak of a third, but certainly very rare 
species, which has been denominated by the French carte seche, an ulceration 
of which the products are absorbed as fast as they are generated. There has 
likewise been observed a species of caries, in which the disease discovered 
after death was comparatively inconsiderable, forming a remarkable contrast 
with the obstinancy and severity of the symptoms which had existed during 
life. Symes draws attention to this fact, and relates one or two striking 
examples. He says " there is in his possession the thigh bone of a woman 
who laboured for thirteen years under caries of the trochanter major, yet the 
whole disease may be covered by the point of a finger, and is not thicker than 
a sixpence." The reverse of this is, however, of most frequent occurrence. 
The quantity of pus which is deposited, particularly when the dorsal or lum- 
bar vertebrae are affected, is sometimes enormous. In a subject who died of 
this disease, which I examined in Basle, Switzerland, a few years since, the 
entire spinal column, from the upper dorsal to the lower lumbar, was im- 
bedded in one large abscess, which, pursuing the course of the great vessels 
through the abdominal ring, formed a double psoas abscess in the groins. 

The amount of pus found in this case was immense, although the pleuritic 
and other symptoms had so veiled the primary disease during life that it had 
not been with certainty diagnosticated. 

In a case of angular disease of the lower dorsal region at present under 
treatment, there is an excessive accumulation of fluid, probably behind the 
peritoneum. The abdomen is swollen to the size of a woman's in the latter 
months of gestation. The intestines are found by percussion to have been 
divided, and pushed to each side, by the gradual advance of the tumour, and 
the double layer of the peritoneum, stretched tightly beneath the integuments, 
seems to render further enlargement impossible. The disease, in fact, appears 
to have been arrested, the swelling having remained stationary for several 
months; while, in other respects there has been a decided and manifest im- 
provement. The lower limbs, which were completely paralyzed, are recover- 
ing their power, the patient having commenced walking with assistance, while 
the distress on assuming the erect or semi-erect position has entirely disap- 
peared. Bespiration, digestion, and other functions are healthy. 

During the early part of the disease, the patient frequently experienced, on 
being moved, a feeling of grating, or crepitus, between the denuded surfaces 
of bone. Appearances and symptoms now countenance the hope that, during 



128 Brown, Case of Extensive Disease of Cervical Vertebrse. [Jan. 

the many months she has observed the horizontal position, with her back 
firmly supported in such a manner as to prevent motion at the diseased part — 
nature being in this way afforded uninterrupted opportunity to perform the 
cure — osseous union has been gradually taking place between the bones. 

The extent to which the bony structures are implicated in this case can, of 
course, only be a matter of conjecture, aided by the appearance of the curva- 
ture, and past experience in similar cases. From the local indications, inde- 
pendent of the amount of fluid, we are led to the opinion that the disease is 
confined within comparatively narrow limits, not extending beyond two, or, at 
the most, three contiguous vertebras. 

Lateral curvature of the spine to the right or left, the most common form 
of spinal deviation, characterized by a greater or less prominence of one of 
the scapulae — which is so prevalent among persons of sedentary habits of 
both sexes, is rarely combined with the formidable disease we are now con- 
sidering. 

In 532 cases of spinal affection which have come under my observation, in 
the practice of Dr. J. B. Brown and in my own, 288 were simple lateral curva- 
tures, 102 angular projections from tuberculous softening and carious disease, 
21a combination of these two forms, while the remainder consisted of poste- 
rior and anterior curvatures, etc. 

Thus, in 123 cases of angular disease, I find 21 only in which this curva- 
ture is united with a lateral deviation.* Duval found a lateral curve in 10 
out of 116 cases of angular projection. 

This infrequency is only what we should expect when we consider the 
want of analogy in the cause, and the comparatively innocent nature of the 
former deviation. 

Both curves, in these exceptional cases, may unquestionably originate in 
the structural disease. But this is not constantly true, as can easily be made 
evident, in the first place, by the general appearance of the spine; the side 
curve being rarely so decidedly angular at any one point, as to indicate the 
existence of a complaint which usually attacks but one or two bones at the 
same time, and also by the consideration of the greater predisposition to caries, 
which characterizes the anterior portions of the vertebrae, where it is almost 
universally far advanced, before the sides are materially affected. It follows, 
then, that for the most part the lateral curve here arises from the same cause 
as when it exists alone. 

The natural curves of the spinal column, and the natural obliquity of the 
pelvis, in angular curvatures, is always nearly or completely obliterated. 
The position of the pelvic cavity, particularly if the projection is in the loins, 

* As a remarkable fact, I would mention that one of these cases, a patient affected 
with severe angular disease conjoined with a lateral curve, when she first came under 
treatment was enceinte with her eleventh child, after having borne ten during the 
twelve previous years. She was at this time thirty-two years of age. 



1853.] Brown, Case of Extensive Disease of Cervical Vertebrse. 



129 



becomes nearly horizontal, and satisfactorily accounts for the rapid deliveries, 
which are reported as so frequently taking place among women affected with 
this form of anchylosis. 

In respect to the frequency of caries in the cervical region, as compared to 
those instances in which the dorsal or lumbar vertebrse are attacked, I find 
but few data upon which to base statistical inquiries. Thus, in Duval's 116 
examples of carious vertebrae, there were 5 only in which the complaint was 
in the cervix. Nichet reports 33 cases, in 6 of which this was the part 
affected. 

In the 123 cases of angular projection from caries, of which I have notes, 
8 had the disease in the cervical vertebrae. In 3 of these, the chin rested on 
the sternum, in 1 only was the head drawn backwards. In the majority, the 
disease was at the root of the neck, in the fifth, sixth, or seventh vertebra. 

These latter have been uniformly marked by the peculiar and characteristic 
symptom to which I have referred, the head appearing as though it had sunk 
or been driven down, wedge-like, between the shoulders. I have, likewise, 
constantly noticed that there is a peculiar respiration attendant on this form 
of the complaint. It is noisy, hurried, and at times painful, yet it is quite 
different from the kind of respiration to which we usually apply the term 
dyspnoea. I have, therefore, avoided the use of this term in speaking of the 
symptom. 

When the upper dorsal are affected, there is not unfrequently disturbed 
respiration, although not usually to the same extent. In many instances it 
is apparently independent of any diminution of the costal cavity. It exists 
where the capacity of the chest has been but little, or not at all infringed 
upon, and owes its origin, either to some functional derangement of the 
nervous system, or, undoubtedly, in a certain number of cases, to undis- 
covered purulent effusion accumulating in the posterior mediastinum, separat- 
ing the pleura from its natural adhesions, thus producing a pressure upon the 
thoracic viscera; the cause of which may not improbably be overlooked, or 
not receive due consideration. The reflex functions of the spinal nerve, as 
concerned in the act of respiration, have appeared to me, even at an early 
stage of cases of this description, often decidedly impaired. Upon such a 
supposition only can I account for the fact, that a considerable amount of 
voluntary effort is necessary to the due performance of the respiratory pro- 
cess. If this act of volition is withdrawn, as in sleep, or when the mind is 
intent upon some object of interest, we have noisy respiration, each expiratory 
act being accompanied by a distinct or smothered groan, which is in truth 
painful to hear, but of which the individual himself appears almost uncon- 
scious. This phenomenon has frequently attracted my attention, although 
I am not aware that it has been elsewhere particularly remarked upon. 

By far the most common seat Of caries of the spine, is the bodies of ver- 
tebrae, particularly the anterior portion. Mr. Potts says that it is always 
thus limited in its effects, seldom or never implicating the articular processes. 



130 Brown, Case of Extensive Disease of Cervical Vertebrae. [Jan. 

Mr. Lawrence states that " this disease attacks only the bodies of the ver- 
tebrae and that " the processes, which are composed of firm, or compact 
bony tissue, it does not attack." Other cases, however, besides the one at 
the commencement of this article, could be cited ; and there are one or two 
specimens in the cabinet of the " Boston Society for Medieal Improvement," 
which prove that the transverse processes and laminae are not exempt from 
the inroads of this disease. 

I have seen two cases, and two only, in which the appearances during life 
were such as would seem to indicate carious destruction of the posterior part 
of the vertebra, in the articular processes, or their vicinity, while the anterior 
remained in the normal state. In the first, one of the spinous processes, in 
the other, two, had sunk from their original level, appearing to have slipped 
forward, as well as downwards, approximating the one below; and the depres- 
sion, which was well defined, would be thus explained. After due considera- 
tion, however, the appearance in question may be accounted for on the more 
plausible conjecture, that, instead of posterior destruction, there was relaxation 
of the ligaments, and swelling of the intervertebral substance anteriorly, suf- 
ficient to separate to a considerable extent the front part of the bodies of the 
vertebrae, producing the effect described. These cases stand alone, and the 
true explanation can only be ascertained by the future course of the disease, 
or by a post-mortem inspection. In one, there was angular disease above the 
depressed spot, with the counterbalancing anterior curve, always present to a 
greater or less extent. In both, there were well-marked manifestations of 
serious injury inflicted on the spinal nerve. 

Of destruction or fracture of the odontoid process of the dentatus, as the 
result of disease, I have been able to find the record of but three cases. 
Ollivier, Delpech, and Sir Astley Cooper, describe each one case. Ollivier, 
in the first volume of his able and comprehensive work, Traite des Maladies 
de la Moelle Epiniere, relates a case somewhat similar to that of young Burr, 
above narrated. The disease, however, was not so extensive, being limited 
chiefly to the destruction of the process and its ligaments. There was, like- 
wise, spontaneous luxation of the upper cervical vertebra, accompanied by a 
gradual relaxation of the capsular ligaments, but no general paralysis. The 
head was so strongly flexed upon the chest, that the skin of the neck formed 
deep folds under the chin, and there was an angular projection formed by the 
spinous process of the axis. This writer states that the case he describes 
was the only one which had come to his knowledge. 

Delpech's case,* is that of a soldier in the Hopital St. Eloi, who had an 
angular inclination of the head on the chest, where it was held by the will of 
the patient, as far as possible, completely motionless. He died suddenly 
from his head falling backward one morning, when he was raised to have his 
bed made. The body of the axis, and its process, was almost completely 
destroyed. 

* De L'orthomorpliie, par Rapport a L'espece Humaine, vol. i. p. 247. 



1853.] McCreery, Accidental Poisoning with Tartar Emetic. 131 

Sir Astley Cooper* mentions the case of a woman in the venereal wards of St. 
Thomas's Hospital, who, while sitting in bed eating her dinner, was observed 
to fall suddenly forward. The patients, on hastening to her assistance, found 
that she was dead. At the autopsy, it was ascertained that the dentiform 
process was broken off, and the head, in falling forwards, had forced the root 
of the process back upon the spinal marrow, which occasioned her instant dis- 
solution. 

In concluding this paper, I would remark that it was far from my intention 
to write a treatise upon the subject to which it relates. I have here briefly 
alluded to but one of the several branches into which derangements of the 
spinal system, osseous and nervous, may be divided. This branch, with 
others, may be more fully discussed at some future opportunity, when more 
extended clinical and pathological observation shall have opened the path for 
a complete and thorough investigation of the various guides by which accu- 
racy in our etiology, diagnosis, and prognosis may be attained, and to the 
benefit which is derived, and which we may expect to derive, from appropriate 
treatment. 



Art. IX. — Case of Accidental Poisoning with half an ounce of Tartar 
Emetic, successfully treated with Green Tea and Tannin. By Stephen A. 
McCreery, M.D., U. S. N. (Communicated by Thomas Harris, M. D., 
Chief Bureau Med. and Surg., U. S. N.) 

On the morning of the 28th of September, 1852, Dr. feeling a little 

indisposed took twelve grains of blue mass. At half past two o'clock P. 31., 
some hours later, he took on an empty stomach what he believed to be (and 
what he had ordered) half an ounce of Rochelle salts with forty grains of 
bicarbonate of soda and as much tartaric acid. Immediately afterwards he 
dined sparingly on ham, the breast of chicken, and tomatoes, and after dinner 
ate two ripe figs. In about thirty-five or forty minutes after taking the 
medicine, he experienced some nausea, but attributing it to his indiscretion 
in having eaten so soon after taking the powder, he resisted the disposition to 
vomit which every moment became more urgent. In the course of four or 
five minutes, however, he was obliged to yield to it, and vomited twice very 
freely, after which he felt relieved. In two or three minutes the nausea and 
vomiting returned, and he then began to suspect that he had received the 
wrong medicine. Instant inquiry was made, and it was discovered that the 
person who had put it up had mistaken the antimonii et potassse tartras for 



* Dislocations and Fractures of the Joints, p. 463. 



132 McCreery, Accidental Poisoning with Tartar Emetic. [Jan. 



the sodee et potassse tartras. Dr. Thomas Williamson, of the Navy, saw the 
patient at twenty-five minutes past 3 P.M., and immediately ordered for him 
copious draughts of green tea and large doses of tannin. Albumen, the 
infusion of flaxseed, and of the slippery elm, and iced water were also freely 
administered. The vomiting, which was very distressing, continued with 
little intermission until 9 or 10 o'clock in the evening. There was also very 
severe purging with most violent cramps of the legs, and slighter ones of the 
wrists. The first evacuation from the bowels was purely serous ; those which 
followed were of a bilious character, but very loose. There were no cramps of 
the stomach. When it was thought that the stomach and bowels had been 
cleared of the poison, an injection containing tincture of opium was given and 
repeated in a few moments. The injections not being retained, a full dose of 
the acetate of opium was administered by the mouth. Brandy mint julep was 
also freely given as the patient was very much prostrated. A large sinapism 
was applied over the epigastric region, and frictions were used to the extrem- 
ities during the paroxysms of cramp. Iced tea and iced mucilaginous drinks 
were continued through the night. 

September 29. The patient passed a better night than could have been 
expected ; was still nauseated, and complained of great thirst, and had some 
headache; the tongue was moist; there was no abdominal pain or soreness, 
or any burning sensation about the stomach ; the bowels were twice moved. 
Iced tea, and iced milk, and arrowroot diet were directed. 

3(M. There was no vomiting or purging; no thirst; diet and drinks were 
continued as before. 

October 1. Rested badly the past night. Had headache and nausea, and 
the tongue was coated with white fur, but there was no febrile excitement. 
The iced drinks were continued, and toast, and coffee, chicken broth, and 
oyster liquor were allowed the patient. 

2d. There was some slight irritation of the mucous membrane of the throat, 
and pain on pressure in the upper and right side of the breast ; no fever. A 
sinapism was applied over the seat of pain, and the slippery elm bark and 
gum Arabic were used to allay the irritation of the throat. The diet and 
drinks were continued. 

4:th. There was still some slight irritation of the throat, and some cough, 
but no pain in the chest nor fever. The patient was allowed full diet. From 
this date he continued to improve, and on the 13 th was able to resume his 
ordinary occupations. 

U. S. Naval Hospital, Norfolk, November, 1852. 



1853.] 



Porter, Obstetrical Cases. 



133 



Art. X. — Obstetrical Cases. — By Isaac G. Porter, M.D., New London, Ct 

Case I. Ovarian Pregnancy. — To those who are familiar with M. 
Pouchet's splendid work, Theorie Positive de V Ovulation JSpontanee, it need 
not be said, that he absolutely denies the existence of ovarian pregnancy. 
His language is : "I have no idea of an ovarian pregnancy, as understood by 
writers, that is to say, a development of an ovulum, still contained in its 
Graafian vesicle; and which, by its development, engenders a foetus, inclosed 
within the very ovary itself." Churchill and Meigs, however, incline to ad- 
mit its existence, and refer to a case recorded by Dr. Granville (London 
Philos. Trans., 1820) as being strongly confirmatory of the position. The fol- 
lowing instance of recent occurrence is, to my mind, quite as satisfactory : — 

July 15, 1852. A married lady, twenty-eight years old, mother of three 
children, the youngest two years of age \ and who, until within a few days, had 
been in perfect health, was this morning attacked, while stooping, with excru- 
ciating pain in the left pelvic region, extending upward as high as the kidney. 
Within half an hour the pain in a great measure subsided; and, under the 
influence of two grains of opium, entirely ceased. On the day following she 
was about the house : the seat of pain, however, remained tender. 

21s£. Another attack of pain was experienced, more violent and continued 
than the first, extending upward towards the kidneys, and through the back, 
resembling, in some of its features, nephritic colic. This suspicion was 
strengthened by the fact that for some days past the urine has been high- 
coloured, and deposits a lateritious sediment. No pain or numbness, however, 
extend down the corresponding thigh. Pulse nearly natural as to frequency, 
but weak and soft ; the patient, mean time, rolling about the bed, dripping 
with cold perspiration. Powerful anodynes and sinapisms were resorted to, 
as were alkalies, directed to correcting the lithic diathesis. 

25^A. Patient had been so comfortable as to sit up most of the day; and, 
though some pain and tenderness existed, was dismissed from further attend- 
ance. To-day, however, she was similarly attacked for the third time. Pain 
excessive, and prostration so great that stimulants in large quantities became 
necessary to prolong life. Distress chiefly in the left side, extending, how- 
ever, over most of the abdomen. There was also retention of urine; and now, 
as for two days previous, a slight sanguineous discharge from the vagina. 
About twelve hours from the attack a powerful reaction occurred. More or 
less tympanitis existed from the first, but calomel, castor-oil, and turpentine 
operated kindly, with large gaseous discharges. The faintness gradually be- 
came more profound, and reaction less efficient. In full possession of her 
mental faculties, death, from anaemia, occurred about thirty hours from the 
commencement of this last attack. 

Autopsy. — Present, Drs. N. S. Perkins, Manwaring, and Hobson. Abdo- 
men prominent, and slightly tympanitic. On making the first incision, bloody 
water gushed out, and, on continuing the dissection, the left side of the pelvis 
was found full of clots and blood, probably in all forty ounces. The left 
ovary was enlarged to the size of a very small hen's egg, of a " black reddish" 
hue, and adhering to its right side were clots of blood. On removing these, 
and making a slight incision, a small quantity of water escaped, followed by 



134 



Porter, Obstetrical Cases. 



[Jan. 



a foetus of perhaps the sixth or seventh week, its size being about that of a 
honey-bee. The Fallopian tube was found floating freely in the cavity of the 
abdomen, and was pervious to the probe, showing that the sanguineous vaginal 
discharge, which occurred during her illness, probably passed through it to 
the uterus. 

Until three or four weeks before the death of this patient, the catamenia 
had been regular, and their cessation, at that time, was suspected to betoken 
pregnancy. About the time of their non-appearance this person, being half 
a mile from home with her child, two years of age, and a violent thunder- 
storm approaching, ran the whole distance, with her child upon her left hip, 
ascending, in the latter part of her course, a steep hill. On reaching the 
house she was nearly breathless, and professed never to have felt quite well 
afterwards. 

In opposition to M. Pouchet's theory, Dr. Meigs has these words, which, 
in connection with the fact just named, go far towards explaining the modus 
operandi of ovarian foetation : " Let us suppose the impregnation to have 
been effected, then some change of position covering the porule with a peri- 
toneal superficies, allowing of adhesion, the ovulum would necessarily be shut 
up in the crypt or cell, which, having now become a shut sac, development of 
the germ would go on, absolutely in the interior of the ovulum, and Gran- 
ville's fact, for facts are stubborn things, would be explained, without at all 
shaking the conclusions as to the oviponte" 

Instances of extra-uterine foetation, including tubular, interstitial, and ven- 
tral, are not very rare on the pages of medical literature; but authentic cases 
of ovarian pregnancy are decidedly so. The earliest on record, according to 
Churchill, was communicated by the Abbe de la Roque, in 1682 : " The 
right ovary was enlarged to the size of a hen's egg, and lacerated through its 
whole length. The foetus was found in the abdominal cavity, in the midst of 
a large quantity of blood." 

Case II. Twins with Impacted Heads. — A young married lady, twenty- 
one years of age, was threatened with premature confinement of a first child, 
at the eighth month. She had been suffering from alternate pains for two 
days before professional assistance was sought; and was at that time feverish, 
pulse 120, with dyspnoea, and a short, dry cough, which had existed some 
weeks. On examination, both feet of a child were found presenting high in 
the vagina. The pains seemed effective and agonizing, still little or no pro- 
gress was made. Soon gentle traction was used, with but slight effect. This 
was moderately increased, but it was three hours before the body was deli- 
vered as far as the head. No force that I was willing to exert had the least 
effect on it (the head), which seemed immovably fixed. The cord had of 
course ceased to pulsate ; the pains were propulsive, and the uterus, though 
somewhat larger than might reasonably be expected from the presence of 
merely the head, yet was rigidly contracted into a hard ball. The case was 
anomalous and alarming, and the assistance of Dr. Perkins, our oldest obste- 
trical practitioner, was sought. Novel and obscure as the case was, we doubted 
whether the head was immensely hydrocephalic, or whether it was retained by 
being jammed between a very protuberant sacrum and the pubis. The parts 



1853.] 



Porter, Obstetrical Cases. 



135 



were so tender that a thorough internal examination was utterly impracticable. 
It was agreed that we were authorized to displace it by a careful application 
of the forceps to the retained head. My friend raising the body of the child, 
I introduced my finger far enough between the head and the soft parts to 
guide the instrument, but the pelvic curvature of the blades being consider- 
able, they applied themselves to the head of another child, lying above the 
pubis; and, with the exertion of moderate force, it (the head) descended, the 
body of the first child, in the mean time, slightly ascending in the vagina. 
For a moment the case seemed more perplexing than ever ; but, while delibe- 
rating on the proper course, a most powerful propulsive pain came on, which 
resulted in the immediate delivery of the body of one child, and soon after of 
the retained head of the other. The patient was, of course, much exhausted, 
but sustained no other injury to the soft parts than the slight rupture of the 
perineum which so frequently occurs in first labours, and which, in this case, 
was perfectly restored in less than a week. But the fever and cough which 
had existed for sometime previous to confinement, continued ; little or no milk 
was secreted; and, after an illness of three months, she sank from pulmonary 
tubercular phthisis. 

Long-continued traction on the neck of the first child had materially dimi- 
nished its size and firmness, so that it furnished no great impediment to the 
passage of the head of the second child. 

Such cases, it is believed, are extremely rare ; but, that others may be pre- 
pared for them, this sketch has been drawn up. A similar one, however, has 
been transferred to this journal (vol. x. p. 238) from the Neue Zeitschrift fur 
Geburtshund. u The body of the first child, which presented the knees, had 
been delivered, and its head was retained by a second child, the head of which 
had descended with that of the first, into the pelvis, which was very large. 
After some efforts the accoucheur succeeded in delivering both children, and 
the mother and one child did well." 

Case III. Vicarious Menstruation. — The subject of the following case 
came under the writer's notice shortly before the birth of her first child, in 
August last. She is a married lady, twenty-three years of age, and menstru- 
ated for the first time when seventeen years old. The discharge was scanty, 
and almost simultaneously with its cessation, a small elevation, like a " blood- 
blister," made its appearance, between one and two inches above the crista of 
the left ilium, and for about twenty-four hours discharged pure blood. This 
occurrence has returned, from that time, monthly, though not with the abso- 
lute regularity of the usual discharge. The first intimation that she is to be 
unwell, is a sense of pain and soreness in the region above indicated. This 
increases until she is uniformly obliged to take to her bed. Sometimes it is 
some days before the discharge commences, which occurs much as the serous 
discharge of a blister; and, after remaining open about twenty-four hours, the 
denuded surface speedily dries up and desquamates, leaving a slight pit or 
depression. One collection remained closed three weeks, causing extreme 
distress and delirium, and while she was tossing about the bed it broke, and 
gave issue to a large quantity of offensive blood. Her health was excellent 
until after she " made the change," since which time, until the birth of her 
infant, in August, it has been infirm- It should be noted, that on an average 
of once a year she has had a sanguineous vaginal discharge, occurring some- 
times with, and sometimes without, the vicarious excretion. Were it other- 



136 



Porter, Obstetrical Cases. 



[Jan. 



wise, the case might be cited as proving that inasmuch as pregnancy occurred 
the oviponte goes on, independently of a sanguineous uterine flow. During 
her pregnancy, the menstrual nisus showed itself regularly after the fourth 
month, from the surface of the left iliac region ; and, on more than one occa- 
sion, seriously threatened premature labour. Her recovery after confinement 
was favourable, and thus far (December, 1852) she has not only been free 
from this abnormal excretion, but has enjoyed excellent health. 

I cannot learn that any active and judicious efforts were ever made to re- 
store the normal discharge. While the case is interesting as showing the 
resources of the constitution, it is presented rather as a pathological curiosity 
than for any practical advantage. 

Case IV. Pseudo- Membranous Inflammation of the Vagina. — This case 
is an exemplification of well-established principles in the pathology of mucous 
membrane ; principles every day exhibited in the membraniform secretion of 
croup, less frequently in the disease called diarrhoea tubularis, where perfect 
casts of the intestinal canal are thrown off, as the result of gastro-enteric 
inflammation ; and more rarely still in the form, position, and extent of the 
present affection. 

An unmarried female, twenty-two years of age, of respectable family, was 
visited for retention of urine as the prominent symptom. It was discovered, 
however, while introducing the catheter, that the parts were hot, swollen, 
tender to the touch, and bathed in mucus; that there were constitutional 
symptoms, pains in the back, &c, denoting intense vaginitis. Very little water 
was removed by the operation, which was very painful. The case was treated 
by absolute rest, saline and other cathartics, balsam copaiba, and camphor, 
tepid mucilaginous injections, and, finally, by injections of nit, argent, grs. v, 
to f^i. "Within a few days, portions of membrane, from the smallest size to 
two inches in length, and one in breadth, began to pass from the vagina, and 
continued until the whole canal was desquamated. 

This condition was undoubtedly superinduced by unlawful irritation, not 
only of the clitoris, but of the whole vaginal canal ; whether as a consequence 
of the intense and indomitable itching, which often results from idiopathic 
inflammation in its first stages, or whether from less worthy motives, cannot 
be decided. 

Ten days after her supposed recovery, this irritation was repeated, and all 
the former symptoms returned with violence. High inflammation of the 
urethra followed, attended by retention of urine. As before, there was con- 
stitutional irritation, pain in the back, nausea, and high nervous excitement, 
amounting almost to delirium. The vagina was much swollen, feeling hard 
and dry, like parchment. Continuing in this state for a few days, it gradu- 
ally became moist, and subsequently softened into a scruffy, bran-like exuda- 
tion, which could be easily removed with the finger. As the amount of 
moisture increased, the matter became slightly adhesive and unctuous, like 
softened Castile soap. After an illness of ten days, she passed entirely from 
our notice, and we are unable to say whether any subsequent adhesions fol- 
lowed. 



1853.] 



Meigs, Inflammation and Hypertrophy of Womb. 



137 



Art. XI. — Case of Curious Inflammation and Hypertrophy of Womb. 
By Charles D. Meigs, M. D., Professor of Obstetrics and Diseases of 
Women and Children in Jefferson Medical College. [With a plate.] 

I beg leave to hand you a drawing, representing, with much faithfulness, 
the appearance of a preparation in my cabinet at the Jefferson Medical 
College. 

I trust you will deem it of sufficient interest to deserve a place in your 
valuable journal. To me it is interesting as exhibiting appearances that have 
not been described, so far as my information enables me to speak, and as 
showing why the ordinary modes of treating affections of the uterus must 
sometimes result in disappointment. I here allude to the treatment of chronic 
inflammation of the os and chirurgical neck of the womb, by topical bleeding 
with leeches, and by the application of various escharotic articles. 

Most generally, the practitioner is satisfied that his duty is fully done by 
cauterizing the parts just named with the nitrate crayon, or with a solution 
of nitrate of silver, or acid nitrate of mercury, conveyed by means of a camel- 
hair pencil, a plumasseau of lint, or by vaginal injection. And true it is 
that when these means are judiciously employed, the happiest effects are 
generally found to ensue as to the re-establishing of the patient's health. 

The drawing represents a womb which is rather more than four inches in 
length, while its greatest breadth is over three inches. Its thickness is ex- 
cessive j in short, the disease of its interior walls has developed a state of 
hypertrophy of the organ, as is evidently the case when we compare it 
with the normal womb, two and a quarter inches long, by one and three- 
quarters wide, and half an inch thick. 

A medical man having charge of a case like the one here represented, and 
examining it by the touch, and also by means of the metroscope, would be 
sure to discover upon the os tincee, and within the os, those appearances usu- 
ally denominated inflammation framboisee, or raspberry-coloured inflamma- 
tion of the os. He cannot possibly diagnosticate the condition of the tissues 
lining the canal of the cervix uteri, because they are inaccessible ; and should 
he expect a cure by repeating his contacts with the nitrate crayon, &c, he 
could not fail to be disappointed, since his antiphlogistic or his destructive 
cauterizations would not even approach the points where their therapeutical 
power is most needed. 

I do not pretend to say that, in a case like the present, any mode of treat- 
ment devisable by the physician could be relied upon; for it appears that the 
changes in the character of the tissue are so great as to leave little prospect 
of a happy result of the treatment, however judicious. 

The drawing exhibits a section from the fundus to the os, laying open the 
cavity of the womb proper, and also the whole canal of the cervix. 



138 Meigs, Inflammation and Hypertrophy of Womb. [Jan. 



If you will look at the cut surface, you will see that it has, near the inner 
wall, the appearance of a collection of pencils or brushes, the extremities of 
which look into the cavity. One might almost suppose this striated or pencil- 
like tissue is an enormous hypertrophy of the tubular glandules of the uterus, 
described by Mr. Gloodsir, Prof. Coste, Sir Franz Kiwisch, and others; and I 
think it probable that such is the fact. Be this as it may, the metroscopic 
examination of it would scarcely fail to mislead one as to his prognosis, at 
least under the ordinary modes of treatment. 

I repeat that an assured diagnosis is impossible. Nevertheless, let the 
physician, in doubtful cases, nay, in all cases, determine the real longitudinal 
diameter of the womb. If that be not augmented considerably, the case will 
not be like this one. If it be augmented, with all the signs of a general 
hypertrophization of the organ, then let him make use, not of the brush, the 
crayon, or the vaginal injection, but of the port caustic of Prof. Lallemand, 
by means of which he can make contacts of nitrate of silver as he may prefer; 
I mean whether merely antiphlogistic ones, or destructive and disorganizing 
ones. This he can effect by regulating the duration of the contact, or by the 
quantity of the salt with which the groove in the platinum rod shall be pro- 
vided. 

As I presume the drawing may be understood without farther description, 
I shall now bring this notice to a close, assuring you of the respectful regard 
of, dear sir, your obedient servant. C. D. MEIGrS. 

To Dr. Hays. 



1853.] 



139 



KEVIEW. 

Art. XII. — The Transactions of the American Medical Association, Insti- 
tuted 1847. Vol. Y. Philadelphia, 1852: 8vo. pp. 940. 

The present volume of Transactions is the most interesting and valuable 
of the five that have been issued by the Association. The change made 
in the character of the principal committees, at the session of 1851, has 
worked well; although reports were received, at the last session, from but 
a few of the committees on special scientific subjects, which have taken 
the place of the former committees on the progress of the several depart- 
ments of medicine, these reports will be read with deep interest, as well on 
account of the importance of the subjects embraced in them, as from the able 
manner in which the respective subjects are discussed. Were the Association 
to effect nothing further than the production of a series of reports similar in 
character to those contained in the volume before us, in reference to all the 
subjects referred to special committees at its last two sessions, its organiza- 
tion will not have been in vain. 

It is to the scientific papers contained in the present volume of Transactions 
that we shall principally direct our attention on the present occasion; glancing 
only at the operation of the Association in the furtherance of its primary 
object; namely, the elevation of the character of the medical profession, by 
promoting a more thorough education of those who are destined to fill its 
ranks, and the inculcation among its members of a strict code of ethics. We 
are aware that, by a few, it is denied that the action of the Association has, or 
can have, any beneficial influence in reference either to medical education or the 
internal polity of our profession. A different conclusion, however, has been 
arrived at by those who have watched, without prejudice, the actual working 
of the Association. They believe that much good has already been effected 
by it, and that ultimately it is destined to bring about all the reforms it was 
organized to achieve. It has not, as yet, it is true, been able to give to medi- 
cal education in the United States that extension and fulness which is desirable, 
nor has it reformed all the evils under which our profession labours. It has, 
however, called, and is still calling into effective operation, the means by which 
alone the ends at which it aims are to be attained. By bringing together the 
leading members of the profession to consult upon the measures calculated to 
promote its general good; by encouraging a systematic organization of the 
regular members of the profession throughout the United States, as well for 
the cultivation of a community of interest, as for the collection into a com- 
mon fund, available to all, the personal experience and observations of each 
practitioner ; by discouraging the admission to pupilage of illiterate and in- 
competent persons; and by directing its influence to enlarge the sphere and 
render more complete the system of private instruction, the Association have 
been laying a broad and permanent foundation, upon which may be securely 
based, hereafter, the entire reform it desires to effect. 

The mere agitation of the subject of medical education, which has been 
brought about by the action of the Association, has been productive of good; 
that it has already exerted a beneficial influence, even upon the schools that 



140 



Review. 



[Jan. 



have rejected the recommendations of the Association, can scarcely be doubted. 
That a very decided improvement in medical education has taken place in 
this country, within the last five years, is very certain; by what means this 
improvement has been effected, is a question in relation to which much differ- 
ence of opinion is to be expected ; for ourselves, we feel no hesitancy in 
ascribing it, in part at least, to the action of the Association. 

An error was no doubt committed by the Association in directing its first 
efforts to a reform of the medical schools. From these latter but little is to 
be expected, until the great body of the profession are prepared to yield their 
support to a more complete and extended system of medical education, and to 
oppose the admission into its ranks of every one upon whom the doctorate has 
been conferred without such an examination as shall fully test his qualifications 
to assume the responsible duties of a practitioner of the healing art. So soon 
as the profession are prepared to demand of the schools an adequate enlarge- 
ment of their courses of instruction, and a strict fulfilment of their duty in 
the graduation of those alone whose competency shall have been fully tested, 
but not before, will they come up to the standard required of them. The 
reformation of the schools must necessarily be secondary to that of the pro- 
fession at large. 

One of the most important of the questions discussed at the last session of 
the Association, is that in relation to a change in its constitution, by excluding 
from it all but delegates regularly appointed by County and State Medical 
Societies. It is all-important that every portion of the profession throughout 
the United States should be fully and fairly represented in the deliberations of 
the National Medical Association, and this would perhaps be most certainly 
obtained, provided there existed a proper and efficient organization of County 
and State Societies in every portion of the Union, by restricting to these 
bodies, as has been suggested, the appointment of delegates. But with the 
present limited and defective organization of the profession in many parts of 
the country, such a restriction would be premature, and instead of working 
satisfactorily, would for some time to come exclude from representation the 
entire body of practitioners of many sections of the Union. But even if this 
were not the case, there are good reasons why the medical Faculties of our 
schools should be admitted to representation in the Association. These reasons 
are clearly set forth in the report of the majority of the Committee to which 
the subject was referred at the session of 1851. 

" Among the prominent objects of the Association," remarks the Committee, 
" are the improvement of medical education and the elevation of the standard 
for the doctorate, and measures for the achievement of these aims must affect 
the interests of the medical colleges. The professors in them, moreover, have be- 
come familiar with the practical working of our system of education, its advan- 
tages and defects, and, from their experience and attention to the subject, must 
possess information which it may be most important for the Association to be 
able readily to elicit, in order that the reforms which it may endeavour to accom- 
plish shall be practicable as well as desirable. Equally important, then, is it 
to those institutions, and to the Association, that they should be represented. 
To the former, that they may have the opportunity of defending their interests ; 
and to the latter, that it may legislate with the knowledge necessary to render 
its measures judicious and fruitful. 

" Further, if the colleges have the favour accorded to them of pleading their 
own cause, they can with the less grace and propriety refuse to comply with 
the recommendations and requirements of the Association." 

After showing that the present ratio of representation possessed by the 
medical schools is too large, and calculated to give to their delegates a pre- 



1853.] 



Transactions of American Medical Association. 



141 



dominant influence over the action of the Association, the Committee re- 
marks : — 

" It is but right, therefore, that the ratio of representation accorded to the 
schools should be reduced ; and it might also, with great propriety, be made 
contingent upon their compliance with certain conditions. By the adoption of 
this plan the Association will acquire some authority over the schools ; and if, 
in the aid of this, those members, who annually so earnestly advocate improve- 
ment in medical education and the elevation of the standard for the doctorate, 
will as sincerely and zealously exert their influence in favour of those colleges 
which concur in carrying these reforms into effect, the recusant schools will 
soon find that a regard to their own interests, of which they have never been 
unmindful, will require them to abandon their opposition to the wishes of the 
profession." 

But one of the prizes offered by the Association was awarded at the last 
session. The successful essay is by Dr. Austin Flint, of Buffalo, N. Y., 
On Variations of Pitch in Percussion and Respiratory Somids, and their 
Application to Physical Diagnosis. 

Sixteen communications were received by the Committee on Prizes j two 
were not examined, one because the name of the author was made known, 
and the other because it was not sent within the time specified. 

Of the thirteen rejected essays the Committee remark that they 

"Were of various merit, and some of them highly creditable to the ingenuity, 
industry, and acquirements of their respective authors, but none of them were 
deemed by the Committee to have enlarged the boundaries or supplied the 
deficiencies of medical science, or to have contributed to the establishment of 
medical truth, in so high a degree, as to entitle them to the award of the pre- 
mium of the Association/' 

The prize essay of Dr. Flint is unquestionably one of very great interest, 
and if the deductions of the author shall be verified by a more extended series 
of observations, he has conferred a very material benefit upon the medical 
profession, by directing attention to variations in the pitch of sounds heard in 
the practice of percussion and auscultation as a means of increasing the value 
of the physical signs of pulmonary disease in their application to diagnosis, 
and of rendering them more readily available for practical purposes. 

Dr. Flint very properly remarks, that 

"The pitch modifications of sound opening a field of study in physical ex- 
ploration as yet but little cultivated, and to which, so far as relates especially 
to auscultation, his attention has but recently been directed, propriety and 
prudence dictate, not only caution for the deductions from a somewhat limited 
number of data, but a certain amount of distrust in a kind of observation in 
which the liability to error cannot be at once fully estimated." 

In view of these considerations, Dr. Flint presents the conclusions advanced 
in the essay before us, " as propositions to be confirmed by further researches." 
His object being, "in a great measure, to invite the investigations of others in 
the same direction." 

The essay of Dr. Flint is divided into two sections, which treat, respect- 
ively, of attention to pitch of sound in the practice of percussion and aus- 
cultation — with a consideration of the variations in the pitch of sounds in 
healthy respiration, and in percussion and respiratory sounds during diseases 
of the chest. A series of clinical observations, embracing a synopsis of the 
characters of respiratory sounds relating to the subject of the essay, are pre- 
sented as an appendix. 

To understand fully the scope and appreciate the value of the observations 
No. XLIX.— Jan. 1853. 10 



142 



Review. 



[Jan. 



of the author on variations of pitch in percussion and auscultation, and the 
application of these variations as a means of diagnosis, the entire essay must 
be read with attention; we can present only the following summary of the more 
important practical deductions submitted in the second section : — 

" 1. In the second stage of pneumonitis, the inspiratory sound is high in pitch, 
followed by an expiratory sound which is frequently, if not generally, higher in 
pitch than the sound of inspiration, these traits being found in conjunction with 
more or less of the other characters which belong to the bronchial respiration. 

" 2. In cases of small tuberculous deposit, or incipient phthisis, the most strik- 
ing modification of the respiratory sound is the elevation of pitch. This eleva- 
tion of pitch is an important element of what is generally known as the rude, 
rough, or harsh respiration. If an expiratory sound be appreciable under these 
circumstances, it may be as high, or higher in pitch than the sound of inspi- 
ration, and the variation of pitch in the former is greater, inasmuch as the 
pitch of expiration in the normal vesicular murmur is lower than that of inspi- 
ration. Elevation of the pitch of expiration, therefore, may be found to be 
valuable as a sign of incipient phthisis in some cases in which the variation 
in the inspiration is not marked. 

"3. If the tuberculous deposit be more abundant, the pitch of respiration is 
in a more marked degree elevated. The expiratory sound, if appreciable, will 
be likely to be as high, or higher in pitch than the sound of inspiration. More 
or less of the other characters of the bronchial respiration are at the same time 
present. 

" 4. In pleurisy with effusion, the pitch of respiratory sound is elevated, in 
conjunction with more or less of the characters of the bronchial respiration, 
over the parts of the chest lying above the compressed lung. In cases of large 
effusion, after its complete removal by absorption, the affected side may con- 
tinue to present a variation in pitch, the symmetry of the two sides being per- 
manently impaired, in this respect, after the vesicular quality of respiration is 
regained. 

" 5. In cases in which tubercle has advanced to the stage of excavation, the 
site of a cavity of considerable size is indicated by a blowing sound, low in 
pitch, with an expiratory sound (if appreciable) lower in pitch than the sound 
of inspiration. These traits constitute the elements of the cavernous respira- 
tion, and the cavernous respiration is the most constant and reliable of the 
signs of an excavation. 

"If the cavity be very large, or there are several cavities, the respiration may 
be modified to such an extent that, on immediate auscultation over the whole 
summit of the chest, it may present the cavernous characters. This may be the 
case while dulness on percussion shows the existence of more or less solidifica- 
tion in connection with the cavities. The coexistence of relative dulness on 
percussion, and a low pitched blowing respiration, denote the predominance of 
excavation. 

" The cavernous respiration may also be present in cases of excavation from 
circumscribed gangrene, and in pneumothorax with perforation. 

" 6. In arrested phthisis, the traces of the disease may be manifested by a 
permanent variation in the pitch of respiration, in connection with more or less 
dulness on percussion at the summit of the chest on either side." 

Four reports were received from the committees on special scientific 
subjects. The first of these is On the Blending and Conversion of Types in 
Fever , by Samuel Henry Dickson, M. D., of Charleston, S. C. 

Dr. Dickson has treated the subject referred to him in a very masterly man- 
ner; his general conclusions are cautiously drawn, and bear the marks of truth; 
while he admits that the types of fever of a very dissimilar origin and charac- 
ter may become blended together in the same case, and that one type may be 
substituted for another; he denies that the conversion, strictly speaking, of one 
type of fever into another can, under any circumstances, take place. 

Dr. Dickson refers to the very loose and indefinite manner in which the 



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143 



term type, when applied to fevers, has been employed even by the most distin- 
guished medical authors. It has been made use of to express promiscuously 
all the varied relations of this class of diseases, '? some of which are those of 
strong resemblance and close affinity, others again of marked dissimilarity, 
and others still, of almost absolute contrast." Although not prepared to 
offer exact limitations to the use of the word type, it must, he considers, be 
understood always to convey some marked distinction, lying deeper than the 
general relations that connect the subjects treated of. While, he remarks, we 
may still dispute whether typhus and typhoid fevers differ essentially, no one 
will confound scarlatina or a tertian intermittent with either. 

" We are persuaded," he says, "that the truth will, on examination, be found 
in the following propositions : 1. That each type, or marked variety of fever is 
the result of a definite cause, relevant in its properties, characters, and mode 
of action, to the effects produced, however obscure this relevancy may be, and 
ill understood, in the present state of our knowledge. 2. That these causes, 
varying greatly in nature, must be sometimes similar, sometimes dissimilar, 
and sometimes contrasted or opposite in the character or mode of their efficiency. 
3. That causes of different kinds may sometimes coexist. 4. That when they 
resemble each other, their effects or influences are really blended and mingled 
and interchanged, as one or the other may predominate. 5. That when dis- 
similar causes coexist, they may sometimes act together, but not often ; may 
sometimes blend their influences, but not readily or freely ; they may possibly 
supersede each other by substitution, but in no imaginable instance can the effect 
of one cause be the effect of another and dissimilar cause. This sort of trans- 
formation, the only true conversion in the logical sense, is a rational impossi- 
bility, whether we regard diseases materially and ontologically as entities, or 
pathologically and dynamically as mere affections of the organism arising out 
of precedent impressions from causative agents. We do not deny the difficulty 
of distinguishing practically, such substitution from conversion so called, we 
desire only to express our meaning precisely, in order that our views may be 
clearly understood." 

" The records before us present numerous examples of the blending of types 
of fever — the intermingling of characteristic features. This is a phenomenon 
by no means rare ; it is for the most part easily explained, and the coexistence 
of more than one cause may usually be indicated to account for it. 

" There are also abundant instances, related upon sufficient authority, in 
which one form or type takes the place of another which has preceded it. This, 
which we shall describe and comment upon, is the conversion of common phrase- 
ology. We have said that we believe it to be correctly substitution, and not 
transformation; but we have no objection to the employment of the above term, 
so convenient, so much more familiar, and, indeed, so indicative of the change 
that has occurred." 

Dr. Dickson supposes, therefore, some special relation to exist among fevers 
apparently derived from the same source that implies their convertibility, and 
believes that it is just as reasonably to be inferred that fevers thus connate 
are exclusively interchangeable ; those which arise from distinct causes, not 
being thus related, are not convertible. 

The periodical fevers, which are referable to a common origin, and con- 
nected by a history of common properties, are referred to as notoriously 
mutable or convertible; the remittent may subside into an intermittent, the 
intermittent being aggravated into a remittent, a quotidian falling into a ter- 
tian or a quartan, and these becoming duplicated, complicated, or exasperated 
into quotidian frequency. 

Continued fevers, while they are strongly contradistinguished from the 
periodical by many remarkable points in their history and character, are, 
also, closely allied to each other, so that the true diagnosis of the several 



144 



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[Jan. 



varieties distinguished by name is still warmly disputed. These, likewise, 
mingle and 'run into one another by blending and interfusion, as might fairly 
be inferred from the prolonged disputes as to their identity, and differences, 
and mutual relations, whether of resemblance or contrast. 

"The exanthemata/' Dr. Dickson remarks, "form a class of fevers which at first 
sight would appear to be palpably and obviously separable from all other types. 
But a more careful examination will show that even here it is not easy to esta- 
blish entirely, and preserve uninfringed, clear boundary lines between neigh- 
bouring and connate maladies. The characteristic features, indeed, of the 
eruptive fevers, are so far unsettled that we find pathologists of high reputation 
including under this head all the continued and some of the uncertain types. 
Both typhoid and true typhus have been arranged here ; yellow fever, which 
has been assigned a position on almost every column of the nosological cata- 
logue, is pronounced by Hildenbrand to be an exanthem; cholera asphyxia is 
thus regarded by Parke, Simon, and Horner ; and dengue — by some merged into 
the ranks of the malarious remittents, by others classed with yellow fever, and 
by Cooke and Copland recognized as a variety of scarlatina — is, to say the least, 
more closely affiliated here than anywhere else." 

Dr. Dickson assumes the establishment of the following distinct types of 
fever : — 

"1. The periodical; including (after Bartlett) the intermittent, remittent, 
and congestive. 

"2. The continued; comprising typhoid, true typhus, simple fever, ephe- 
mera, febriculse, British epidemic fever, relapsing fever. 

"3. The exanthematous ; variola, scarlatina, measles, dengue. 

" 4. YelloAv fever; the ' hgemagastric pestilence' of Copland, causus of Mosely, 
typhus icterodes of Cullen, malignant remittent of Bush. 

"5. Catarrhal fever, known when epidemic as influenza." 

The question as to the blending of these several types is very fully and 
satisfactorily discussed. The subject of the apparent conversion of the types 
of fever is next considered. 

"The examples above given of the mingling and interfusion of symptoms 
of two or more forms of fever," says Dr. Dickson, " differ among themselves 
in the greater predominance of one morbid influence or another in the several 
cases. Of numerous attacks which commence in the same way, the course, 
history, and ultimate termination may be strikingly diverse. Invading with 
the ordinary symptoms of climatorial, autumnal bilious fever, one shall retain 
its periodical malarious character, ending, as it begun, with the features of a 
simple remittent. Another, losing these features in a protracted course, shall 
grow more and more continuous, and, ultimately, put on all the appearances of 
maculated typhus, with dry, dark tongue; mouth, teeth, and gums blackened 
with sordes; or present the meteorism and abdominal disorder of typhoid, 
with intestinal ulceration shown post mortem. ; and a third shall sink promptly 
into profound collapse, dying with orange-yellow discoloration of skin and eyes, 
and black vomit. If we suppose these to have been all struck down by mala- 
ria, in a locality infected by the coexistence of the three morbid poisons, it is 
easy to imagine some of them to come under the influence of ochlesis, the 
alleged source of typhus and typhoid, and others, strangers and predisposed, to 
fall victims to the obscure cause of the hgemagastric pestilence. We may cor- 
rectly assume that, in all these, a temporary blending of types took place at a 
certain stage of their progress, under the conjoint influence of the several con- 
current causes. As they advanced, however, the more intense or forcible in- 
fluence would predominate ; generally speaking, the malarious characteristics, 
periodicity, especially, would disappear, being substituted or supplanted by 
those of the more malignant poisons ; a virtual and complete conversion of type. 
In this sense, then, we believe that conversion is not only possible, but fre- 
quent, and shall proceed to adduce in proof a few additional evidences." 



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One more extract from this interesting report must suffice 5 all we desire 
being to present to our readers a fair exposition of the general positions as- 
sumed by the author in reference to the blending and conversion of types in 
fever. 

" If," Dr. D. remarks, " contagious diseases can be originated or generated 
under any contingency whatever, and no one can doubt the possibility of 
this occurrence, and if the matter of contagion is, as indeed it must be, a 
vital individuality, a self-multiplying germ, capable of indefinite reproduc- 
tion, then the creation or development of this new cause must give rise to 
new results. A new form of disease now presents itself, which either blends 
with that which pre-existed, or supplants and substitutes it. If the causes 
of the two are connate and correlated, and in any degree similar or analo- 
gous in influence, blending of type takes place ; the more especially if they 
are nearly equal or quite equal in force, and circumstances do not strongly 
favour either at the expense of the other. But if they be markedly dissimilar 
or contrasted, or in any manner incompatible, or if circumstances favour the 
one and repress the other, then there will and must happen the subversion of 
the first, the weaker or least tenacious ; and conversion of type will take place, in 
the only sense possible and intelligible/' 

The second report is On the Action of Water on Lead Pipes, and the Dis- 
eases proceeding from it. By Horatio Adams, M. D., of Waltham, Mass. 

The subject of this report is a most important one. The conveyance of 
water through leaden pipes for all domestic purposes is almost universal 
throughout the United States, especially in the larger cities. The question, 
then, does the water thus conveyed become impregnated with any of the salts 
of lead so as to affect injuriously those who make use of it as a drink or in 
the preparation of food, is one in which every citizen is deeply interested. 
The conclusion to which the facts adduced in the report before us very clearly 
lead is, that, under certain circumstances, at least, water conveyed through 
leaden pipes does acquire poisonous properties, in consequence of which dis- 
ease of a most serious and painful character is induced in those who drink it. 
That this deleterious action of leaden pipes upon water conveyed through 
them, when it takes place, is due to the latter being impregnated with certain 
chemical agents that act upon the lead, and form with it soluble salts, we 
should infer from the fact that a large proportion of the inhabitants of 
Philadelphia, have for nearly fifty, certainly for thirty years, been supplied 
through leaden service-pipes with the water used by them for all domestic 
purposes, and yet the diseases ascribed to the use of water impregnated with 
lead in Dr. Adams's report are certainly with us of very rare occurrence. Our 
physicians, it is true, meet occasionally with saturnine colic and paralysis from 
lead, but invariably under circumstances where the introduction of lead into 
the system is from sources altogether independent of the lead-transmitted 
water taken by them as drink. 

In a most interesting report on the action of Cochituate water on lead 
pipes, and the influence of the same on health, by Dr. Jacob Bigelow, 
contained in the number of this journal for July, 1852, a similar remark is 
made, in reference to the city of Boston. 

"From an extensive inquiry among physicians," says Dr. Bigelow, " and also 
from the bills of mortality, they (speaking of the committee by which the ques- 
tion comprising the subject of the report referred to, was investigated) are led 
to believe that the health of the city of Boston has been uncommonly good 
during the last two years, and they have not learned that any well-marked cases 
of the diseases usually attributed to lead, have occurred, which were not trace- 
able to some other cause than the use of Cochituate water, drawn from lead 
pipes." 



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[Jan. 



It is admitted in the report before us " that pure water exerts no effect on 
pure metallic lead. Pure water is never decomposed by pure lead." But 
pure water, that is, water free from all uncombined oxygen, acids, and alka-. 
line, earthy, and metallic salts, does not exist naturally. 

"The effects of natural water in relation to. lead are alone," Dr. Adams re- 
marks, " to be investigated. The action of natural water on lead is due to 
foreign matters contained in water. All natural water contains air, acid, gas, 
and salts. These all exert an effect more or less direct on lead. The salts 
cause water to be hard or soft, and these qualities modify the chemical rela- 
tions of lead and water. The salts in natural water are either neutral or non- 
neutral ; the last are all alkaline. The neutral are sulphate of lime, common 
salt, earthy and alkaline nitrates, and chlorides. The alkaline consist of bicar- 
bonates of lime and magnesia, sometimes of bicarbonate of potash and soda. 

"These several substances act, either singly or combined, on lead. Single 
action is generally direct, combined action is always indirect. Hence, the 
foreign matters in water may be divided into direct and indirect agents. The 
first class comprises oxygen, chlorine, and compounds of sulphur and hydro- 
gen. The second class comprises the alkaline, earthy, and metallic salts, and 
organic or inorganic acids. 

"Among the foreign matters, oxygen exerts, perhaps, the most important 
influence in determining the action of lead and water ; when absent from water, 
action will rarely occur; its action is primary. With the exception of chlorine 
and hydrosulphurous compounds, no other agents act primarily, and direct 
action always precedes indirect, primary always precedes secondary action. 

" Pure metallic lead cannot be put in contact with any direct agent in water 
without being acted on by it, and the results of this primary action are oxides, 
chlorides, and sidphurous compounds of lead. 

"The degree of oxidation depends on the amount of common air, carbonic 
acid, and oxidizing agents in the water. If only a small amount of air or free 
oxygen is present, a compound of two proportions of lead to one of oxygen, or 
a suboxide is formed. If carbonic acid and oxidizing agents are more abundant, 
then a higher degree of oxidation, one portion of lead to one of oxygen, or a 
protoxide, occurs. All natural water contains oxidizing and decomposing 
agents, which readily change the lower oxide into a higher oxide of lead ; hence 
it may be said that the result of direct action is the formation of protoxide, 
chloride, and sulphurous compounds of lead. "Water containing hydrosul- 
phurous compounds is never used for domestic purposes ; hence, practically, the 
only compounds of lead here to be considered are the protoxide and chloride. 

"Bearing these principles in view, it is evident that, since all natural water 
contains direct or indirect agents, all natural water acts on lead. The result of 
this primary action is the production of an oxide or chloride of that metal." 

After noticing the various conditions of natural water by which its action 
on lead is augmented or diminished, Dr. Adams remarks that 

" The actual amount of the lead-solving power of any water is of little mo- 
ment. It will become important only when it shall have been determined what 
is the minimum of lead which can exist in water, when used as a beverage, 
without detriment to health ; a question as yet wholly undecided." 

" In numerous cases of well-defined, unmistakable lead disease," it is subse- 
quently stated, " which have come under the observation of some of the members 
of the Committee, the water suspected to be the cause of disease has been che- 
mically examined. While, generally, it maybe said that the amount of lead in 
solution would not fall below one-twentieth of a grain per gallon, yet the cases 
have not been rare where disease has been produced by less than one-hundredth 
of a grain of metallic lead per gallon in solution, or one in seven millions of 
water. One-hundredth of a grain of lead is easily detected by a simple stream 
of sulphuretted hydrogen. Water has sometimes caused disease, under the 
eye of a part of your Committee, where this test showed no trace of lead ; yet 
lead was abundantly evident after concentration of the water, and the sulphuret 



1853.] 



Transactions of American Medical Association. 



147 



thus obtained has been converted into salts of lead, which have been again 
examined to confirm the hydrosulphurous test. Small as the amount of lead — 
less than one-seven-millionth of the weight of water — in solution thus appears, 
the Committee are disposed to place it still lower. The Tunbridge well may be 
adduced, whose waters, flowing through a lead pipe, disordered many who 
drank it ; and it contained so minute a trace of lead in solution, that some of 
the most acute and eminent chemists of the day — men full of chemical tact and 
laboratory experience — failed to detect its presence. Happily for the afflicted, 
lead was at last detected, the pipe was removed, and health returned/' 

If all water used for domestic purposes, when transmitted through a leaden 
pipe, becomes impregnated with the metal, and " the purer the water and the 
greater its aeration" the greater is the extent of the impregnation; if the ex- 
tent of the impregnation sufficient to render the water deleterious to the health 
of those who use it for dietetical purposes may be so slight as to prevent its 
being detected by the ordinary chemical tests, how happens it that entire 
communities — as in the case of Philadelphia — have made use of water trans- 
mitted through lead pipes, for more than a quarter of a century, with, ap- 
parently, entire immunity from disease traceable to its influence, certainly 
without experiencing any of those affections known to be the result of lead- 
poisoning. 

That lead-transmitted water will produce disease in those who use it as a 
drink, the facts adduced in the report before us incontestably prove ; that, 
however, such water will, in certain localities, prove perfectly innocuous, is 
equally certain ; to ascertain the cause of this difference of effects, is deserv- 
ing of a careful investigation. 

" The salts of natural water,'' remarks Dr. Adams, " were at one time thought 
to be protective against its lead-solvent power. To a limited degree, this is true 
of water holding in solution bicarbonate of lime, a deposit of carbonate of lime 
gradually incrusting the interior of the pipe. But, as we have no analysis 
recorded of the water thus flowing through a pipe lime-coated, it is impossible 
to say whether bicarbonate of lime has ever prevented gradual corrosion of the 
lead. 

" The doctrine of protective power has been much extended within a few 
years. It has afforded, and still affords, to many minds, an argument for the 
safety of water lead-transmitted. This doctrine has assumed various phases, 
which may be reduced to the three following: — 

"1. Protection by certain salts of the 'right kind/ present in water in a 
limited proportion, or by salts artificially introduced for the purpose of produc- 
ing compounds of lead known to be insoluble in pure water. In the latter case, 
the pipe filled with a solution of the protective salt must be left closed for some 
months, to allow a protective coat to be formed. 

" This may be called the Edinburgh doctrine, having been promulgated and 
advocated by Dr. Christison, of that city. 

"2. Protection by the formation of an insoluble coat of suboxide of lead after 
a few days, or at most a few weeks' contact with water. This may be termed 
the Boston doctrine. It was there adopted as the ground of safety of using 
lead service-pipes for lake water; fortified, as it was, by the belief that the 
inhabitants of other cities, using river or lake water lead-transmitted, had been 
protected from lead disease by the formation of an insoluble coat. 

"3. Protection by the presence of a limited amount of carbonic acid present 
in the water, forming insoluble carbonate of lead. This is the latest, and it 
may be termed the London doctrine. 

" It is assumed by the eminent chemists by whom this doctrine has been 
advanced, as the ground of their belief, that the present distributing lead pipes 
in London may safely be continued if that metropolis should hereafter be sup- 
plied from the newly-proposed sources with a constant supply of soft water. 

" The advocates of protection/' says Dr. A., " seem not to have duly considered 



148 



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[Jan. 



that their several protective coats, however insoluble in pure water, are decom- 
posable and soluble by the salts contained in natural water. The Edinburgh 
doctrine has been practically abandoned by its author. 

" The Boston doctrine has been disproved by the results of analysis of water 
at present flowing through the lead service-pipes earliest laid down by the city 
authorities. The London doctrine is yet to be proved, but its authors admit 
that an excess of carbonic acid will dissolve the coat of carbonate, and thus the 
water will be rendered deleterious if the solved lead exceeds one-twentieth of a 
grain per gallon. 

" The whole doctrine of the protective power by the formation of an insoluble, 
impervious coat on lead, by the action of the impurities of water, is set aside 
by the fact that, however this coat may be formed, lead transmitting water is 
constantly dissolved. No limit of time has yet set bounds to this action. This 
is the lesson of experience taught by the erosion of lead-pipes and cisterns. It 
is the result of experiment that, where no perceptible action is visible, chemical 
examination detects lead in solution. Without going into detail, by adducing 
evidence on these points, by citing the statements which, within a few months, 
have been made to learned associations by scientific men, or to parliamentary 
committees by practical plumbers, of the ceaseless corrosion of lead by water, 
the Committee would remark, that the doctrine of protection is no longer tenable 
on scientific or practical grounds. Still, it is a doctrine which has many 
advocates, and exerts an influence on many minds, which is much to be de- 
plored, viewed as a question of public hygiene/ 7 

The second section of the report under consideration is devoted to a con- 
sideration of " the diseases which proceed from the use of lead-water/ 7 This 
the Committee pronounce the most difficult part of the duty assigned to them, 
and which they feel their inability to do justice to ; the subject requiring " a 
more thorough research than the limited opportunities of observation falling 
to their lot have enabled them to bestow upon it;" a subject they have but 
just entered upon, but which " they hope those who have a wider field of ob- 
servation may, ere long, more fully develop." 

This portion of the report is, nevertheless, replete with interest and much 
practical instruction. Notwithstanding Dr. A. has followed very closely the 
admirable descriptions furnished by Tanquerel, of the primary effects of lead 
when introduced into the system, and of the several forms of disease directly 
traceable to the poisonous influence of the metal, yet the illustration of these 
diseases, their characteristic phenomena, their march, and usual terminations, 
as well as of their proper therapeutical management, derived from the per- 
sonal observation of Dr. A. and his colleagues on the Committee, or furnished 
by their medical friends, gives to this portion of the report an originality and 
value that should recommend it strongly to the attention of the profession 
throughout the United States. 

" Science," it is remarked, " has not, probably, yet revealed all the diseases 
which proceed from lead taken into the human system. Several serious dis- 
eases, however, at the present time, are well understood to have their origin in 
the absorption of this poison, while others, scarcely less severe and distressing 
in their character, have not as yet been definitely proved to be thus produced, 
although many of them have fallen under strong suspicions of having a satur- 
nine origin. Several of these, as some forms of dyspepsia, neuralgia, and 
rheumatism, from their well-known resemblance to other forms of lead disease, 
have been so classed by many very intelligent and observing physicians. " 

The third report is On the Permanent Cure of Reducible Hernia, by George 
Hayward, M. D., of Boston, Mass. This paper presents a condensed, but clear 
and very satisfactory sketch of the several operations that have been practised 
for the radical cure of reducible hernia. The objections to each are pointed 
out, and the difficulties attendant upon every means that can be employed, 



1853.] Transactions of American Medical Association. 



149 



with safety, to establish a permanent barrier to the descent of the bowel, in 
cases of reducible hernia, are discussed with a precision that gives to the 
report a peculiar practical value. The conclusions at which the Committee 
have arrived, after a careful examination of the subject, are thus stated : — 

" 1. That there is no surgical operation at present known which can be relied 
on with confidence to produce, in all instances, or even in a large proportion of 
cases, a radical cure of reducible hernia. 

" 2. That they regard the operation of injection by the subcutaneous method 
as the safest and best. This will, probably, in some cases, produce a permanent 
cure, and in many others will afford great relief. 

" 3. That compression, when properly employed, is, in the present state of 
our knowledge, the most likely means of effecting a radical cure in the greatest 
number of cases." 

On the subject of compression with the view of effecting the permanent 
cure of hernia, the Committee remark as follows : — 

" It is an unquestioned fact that reducible hernia is often cured in young 
subjects. It may be accomplished in them by various means ; but it should 
not be thence inferred that the same course would uniformly produce like 
effects in adults. 

" It may be remarked that, in children, any method which can prevent the 
protrusion of the hernia for a year or more will, in all probability, produce a 
permanent cure. If the aperture, through which the contents of the sac must 
pass, can in any way be prevented from enlarging, while the viscera of the 
abdomen are increasing in size, it is obvious that a great length of time would 
not be required to render an escape of any of the abdominal organs difficult, if 
not altogether impracticable. We see familiar examples of this daily in umbili- 
cal hernia, which is brought on so often in infancy by hooping-cough and 
various other causes. Compression, it is well known, will, in all such cases, if 
carefully practised, in a comparatively short period, produce a radical cure; 
and it is a valuable agent in the management of reducible hernia at every period 
of life. It has been used from the time of Celsus to the present, and it has not 
unfrequently succeeded in producing the desired result. It is usually applied 
at the present day by means of trusses. Great improvement has, of late years, 
been made in their construction. It cannot be doubted that an instrument of 
this kind, when nicely adjusted, so as to cause no pain or inconvenience, and 
at the same time to compress the neck of the sac, may, if used for a considera- 
ble length of time, prevent, in many cases, the subsequent protrusion of the 
hernia. 

H It is well known that pressure upon a serous membrane, when carried to 
a certain extent, will cause an effusion of fibrine on its inner surface ; and it 
was from a knowledge of this fact that, in former times, the method of treating 
aneurism by compression was adopted. This mode often succeeded in pro- 
ducing a radical cure by closing the artery leading to the aneurismal sac. The 
practice has been revived with great confidence within the last few years, and 
the results hitherto have been equal to the expectations of its advocates. 

" In the treatment of hernia in this way, it is of the utmost importance that 
protrusion should not be allowed to take place at any time ; ' for if the hernia 
once descends during the wearing of the truss/ as Sir Astley Cooper well re- 
marks, ' the cure must be considered as recommencing from that moment/ 
The truss, therefore, should be worn by night as well as by day. 

"It is important, also, that while the pressure is sufficient to prevent the 
descent of any of the abdominal contents, it should not be enough to cause any 
considerable degree of inflammation. This would not only require the truss to 
be laid aside altogether, but it would also stop entirely the effusion of fibrine. 
In inguinal hernia, the pad should be so placed as to compress the inguinal 
canal ; and, at the same time, great care should be taken to avoid pressing the 
spermatic cord against the pubis. 

"A radical cure will not be effected in this way, unless the compression is 



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[Jan. 



continued for a length of time. It cannot be reasonably looked for in an adult 
in less than two years from the time the truss is first worn ; and it can hardly 
be expected at all in persons after the middle age of life, who are afflicted with 
a direct inguinal hernia of long standing. At the same time, more benefit is 
derived from compression in such cases than from anything else, and persons 
in this situation are not safe without it." 

The fourth and last of the reports from committees on special scientific 
subjects, is On the Topical Uses of Water in Surgery, by Charles A. Pope, 
M. D., of St. Louis, Mo. 

The therapeutical uses of water, whether given internally, or applied exter- 
nally, have not escaped the attention of physicians. Of its effects as a reme- 
dial agent, we find frequent mention made by medical writers of almost every 
period in the history of our art. Although in the various mutations which 
the catalogue of the materia medica has undergone, it may have ocasionally 
been omitted ; although it may have been estimated occasionally either beyond 
or below its true value ; although the proper mode of its administration may have 
been misunderstood, or the character and stages of disease or injury most 
favourable for its employment, may not have been accurately determined ; 
still, its beneficial influence, when resorted to at various degrees, of temperature, 
or in the form of ice or steam, has, we believe, never been entirely lost sight 
of by either the physician or surgeon. 

To determine with accuracy the real value of water as a remedial agent, 
and to settle the rules for its employment, and the circumstances under which 
it will prove most advantageous when administered internally or externally, 
warm or cold, in its solid, liquid, or vaporous state, continuously or inter- 
ruptedly, by affusion, fomentation, irrigation, lotion, immersion, injection, or 
douche, etc., would confer a benefit of no trifling magnitude upon both phy- 
sician and surgeon. When the true therapeutic philosophy of water shall be 
well understood, it will be found, we are convinced, of a much more extended 
and efficacious application in the treatment of diseases and surgical accidents 
than is now generally supposed. 

In the report before us, Dr. Pope has noticed simply the local external 
effects of water in the department of surgery. Although he has by no means 
exhausted the subject, he has, nevertheless, presented it in a point of view 
well calculated to direct to it a greater degree of attention than it has yet 
received. 

The following are the cases indicated by the reporter as those in which the 
continuous use of cold water is advantageous : — 

" 1. As a local anaesthetic. From the effects which we have described as 
following the application of water of a low temperature, we should, a priori, 
infer its use in obtunding sensibility. We produce a frost-bite of the first degree, 
when the part is said to be ' dead/ Benefit in this way can only be obtained in 
parts of no great thickness, as the phalanges of the fingers and toes, amputa- 
tions of which have been thus performed without the patient experiencing the 
least pain. General anaesthesia by the usual means of ether or chloroform 
inhalation will for such purposes, on account of a more rapid indication^ the 
desired effect, be perhaps preferred; still, cases contraindicating the exhibition 
of these very exceptionally dangerous agents may occur, when for the removal 
of fingers or toes or the ablation of certain tumours, as we have ourselves prac- 
tised, it may be desirable to resort to other means, or to the local anaesthetic 
power of cold. Here, as in other instances to prevent undue reaction^ the cold 
applications of a gradually more elevated temperature should be continued as 
the after-treatment. Do not ether and chloroform produce local anaesthesia by 
their evaporations inducing cold ? Certain it is, we think, that their major action 
may in this way be explained, as their local and general effects seem so widely 
to differ. 



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"2. In inflammation of particular parts, as (a) in inflammation of the brain, 
especially when induced traumatically. Notwithstanding the fear once felt in 
the use of cold applications to the head, they are now, next to bloodletting, 
generally acknowledged to be one of the most powerful remedies in the treat- 
ment of such affections, (b). In ophthalmia, attended with ocular pain and 
cephalic congestion. Some of the German surgeons are fond of cold applications 
in all purulent ophthalmia, as they think that they prevent the discharge and 
mitigate the violence of the disease. Here, too, its place is next to bloodletting. 
In the ophthalmia neonatorum, cold water has been found very serviceable, and 
excellent success has also attended its employment in scrofulous photophobia. 
In simple catarrhal ophthalmia, cold applications should not be too long con- 
tinued. Their good effects are most marked in the earlier stages, when, fail- 
ing, their continuance is likely to induce a rheumatic complication. Poppy and 
other anodyne fomentations are then preferable. 

"(c). In traumatic inflammation of the thoracic and abdominal cavities, as 
contusions, wounds, etc., attended by extravasation of blood. Many surgeons 
who employ cold applications in affections of the limbs fear their use about the 
trunk on account of the proximity of serous surfaces, which they allege take on 
consequent inflammation. Marshall Hall strongly recommends them even in 
metro-peritonitis with decided advantage. But in these cases there is danger, 
for, as it is difficult for the cold to act except at the periphery, it may cause 
deep-seated congestion. Hence? if water be applied at all, it should be in an 
uninterrupted manner, and at a very low temperature, so as to diminish the 
circulation of both the superficial and central vessels. Our own experience is 
decidedly favourable to cold applications in bleeding, and penetrating wounds 
of both cavities of the trunk, and we have not noticed the production of this 
dreaded pleurisy or peritonitis to be attributable to their action. Is there not 
also a serous membrane of the brain? But we are not on this account deterred 
from their use in traumatic lesions of the head. The osseous envelop is not a 
sufficient explanation of the difference in the two cases. 

" (d). In orchitis, cold applications act most beneficially, so long as the true 
sthenic character prevails. According to Hush, their use should not be too 
long continued in the inflammation of glandular organs, because of the indura- 
tions which are likely to follow. This surgeon is very partial to the use of cold 
water in almost all external diseases, but for the reason assigned does not admit 
its employment in orchitis even of a traumatic origin. He prefers, in such cases, 
warm sugar of lead fomentations. This induration, with enlargement, almost 
always follows inflammation of the testicle as an immediate consequence under 
every treatment, and I am not aware that it more frequently follows the use of 
refrigerants than other remedies. In the earlier active stages of orchitis their 
use will, as in other inflammations, be found on trial consonant to the general 
rule. 

"In inflammatory enlargements of the superficial lymphatic glands of the 
groin, along with rest and a compressive bandage, we have found cold applica- 
tions very useful in effecting a return to their normal size. There are buboes 
which will suppurate in spite of all and every treatment. In such, the specific, 
for example, where suppuration is by many regarded as an elimination of the 
poison, we withhold the use of refrigerants. 

" (e). In inflammation of mucous surfaces, as gonorrhoea, leucorrhoea, chronic 
cystitis, etc., the applications of cold water, either by fomentations, irrigation, 
or injection (in case of the bladder by means of a double catheter), are very 
useful. The cold imparts tone and strength to the relaxed and weakened mem- 
brane. In the case of the penis, local cold-baths are generally to be preferred 
to injections. Uterine injections, however, have of late years met with favour- 
able reception in practice. 

" {/). In paraphymosis, the use of cold water is highly serviceable. It 
diminishes inflammation and engorgement, whilst it favours the spontaneous 
reduction of the glands, or proves an efficient aid to the manipulatory efforts of 
the surgeon. The water should be poured upon the part from a height for 
twenty minutes or half an hour before attempting the restoration. We have 



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[Jan. 



never yet seen a case at all acute which has resisted this means and required a 
resort to the knife. 

"Cold applications are applied not only to cure inflammation already esta- 
blished, but far oftener to prevent its accession when likely to follow previous 
injuries. With this view are they especially used — 

" 1. In wounds. The more important the organ injured, the more we should 
strive to ward off inflammation, and consequently the more urgently are cold 
applications indicated. In wounds of the head, of the external soft parts, as 
well as of the cranium and brain, in wounds of the chest and abdomen, either 
penetrating or not, and, lastly, in wounds of the extremities, cold water is a 
chief remedy, and should never, unless for major reasons, be neglected. Its 
beneficial effects are most marked in incised wounds, as amputations and the 
like, where we wish union by the first intention. This important and generally 
desirable process is not in the least hindered, but, on the contrary, is often 
promoted by the judicious use of refrigerants. In lesions implicating joints 
(especially the knee) and peri-tendinous sheaths, no other application is supe- 
rior, although we should not neglect venesection and other means of cure. 
Did it comport with the plan of the present paper, we might cite many striking 
cases in illustration of the great benefit of cold applications. 

" In contused, lacerated, and gunshot wounds, they are no less serviceable. 
Here, it is true, that a certain amount of inflammation must follow, nor is it 
intended, as some suppose, altogether to prevent its occurrence. We aim sim- 
ply to moderate and restrain, not to prevent or absolutely to control. In the 
first period of gunshot wounds, that of shock, cold applications ought, for obvious 
reasons, to be withheld. As this state passes off, they should, however, be sedu- 
lously made. While, on the other hand, there is but little doubt that in many 
a grave gunshot, or other injury, were the treatment by continuous irrigation 
or immersion in cold water, amputation might be often prevented, and thus 
both life and limb saved ; on the other, in those comminuted fractures with 
division of large bloodvessels and nerves, and other serious disorder, we should 
not indulge the vain hope of saving by water or any other treatment, that which 
it would be both safer and more useful to remove. 

" As to the length of time required for applying cold water, it will depend 
evidently on the circumstances of the case ; a few days being sometimes suffi- 
cient, while in others a month or more is necessary. Instances are given in 
which the applications have been continued for three months. It is important 
to remember that, when from any cause it may be deemed advisable to discon- 
tinue the application, it should not be done suddenly, but gradually, and by 
the substitution of water of a more and more elevated temperature. By this 
means the rapid and undue reaction will be prevented, and a more formidable 
inflammation averted. 

" With respect to the danger of mortification from the continuous application 
of cold, it is by no means clear that the contusion itself was not the chief cause 
of the mortification in cases where this has taken place. Certain it is that 
snow and ice would more likely predispose to this untoward accident, which the 
judicious surgeon can generally foresee and prevent. Berard has twice seen, 
under these circumstances, the mortification of the great toe. Whenever the 
connections of the contused part are such as seriously to interfere with its cir- 
culation, gangrene is to be apprehended, and cold applications are to be most 
warily used. So, too, in severe fractures, accompanied by paralysis, the vitality 
of the part being lowered, the danger of mortification by continuous cold is 
enhanced. 

" Another objection to continued irrigation has been made by M. Piorry. It 
is, he says, a kind of injection, which dissolves the pus, introduces it into the 
open vessels, and thus causes pyaemia. The removal, by such means, of the pus 
and septic detritus of a part, was, it would seem, a means rather of preventing 
than of inducing systemic infection. Besides, under the use of cold water, the 
quantity of the discharge is diminished, and there is, consequently, less danger 
of absorption. 

"2. In concussion, particularly of important organs, as the brain, lungs, and 
abdominal viscera. Here, of themselves, cold applications are often sufficient 



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to prevent the development of inflammation. It is important to recall the fact 
that, in all cases of severe shock, the system should be permitted to recover either 
naturally or by restoratives, before resorting to irrigation or immersion. 

" 3. In bruises or contusions of soft as well as of hard parts ; in fractures, 
luxations, and sprains, cold applications are used according to the same rules. 
In sprains, momentary luxations self-reduced, conjoined with rest and position, 
no remedy is equal to them. In the swelling and pain which so soon follow on 
fractures and dislocations, cold water, by abating both symptoms, is an admir- 
able aid in enabling us to examine satisfactorily, in order to an exact diagnosis. 
It is equally serviceable in their after treatment. Dupuytren supposed that 
cold, whether by water or the atmosphere, retarded and occasionally prevented 
the formation of callus. This can be true only when the fractured bone is near 
the surface, and when the cold is applied to such a degree as to diminish that 
vascularity of the part necessary to the formation of callus. 

" 4. In incarcerated and strangulated hernia, cold water not only prevents 
the expected inflammation, but also greatly assists the taxis by its contractile 
effects. It is when the protruded bowel is greatly distended by flatus that its 
beneficial influence is most marked. Freezing of the parts, in such cases, is 
said to have occasionally occurred, an event which moderate attention might 
easily forestall. In prolapsus of the rectum and of the vagina, as also in hemor- 
rhoids, cold water often proves salutary in facilitating the reduction of the dis- 
placed parts, on the one hand, while, on the other, it prevents the inflammation 
which might follow. 

"5. For the cure of aneurism and varices. Combined with compressive 
bandages, cold water has been used with success, especially if the case be recent. 
It has generally been restricted, except as an adjuvant to compression, to inter- 
nal aneurisms, as of the aorta, &c. ; the external being amenable to more certain 
means of cure. The examples of success, according to the method of Valsalva 
and Albertini, are in part to be attributed to the continued application of cold. 
Ice has cured aneurism ; but the best mode of applying cold is to envelop the 
whole limb, including the aneurism, with a roller, which should be kept con- 
stantly wet with water at a low temperature. In cases of internal aneurism, 
where a cure is not effected, the cold serves at least to delay the fatal termina- 
tion. 

" 6. In all degrees of burn, cold applications, although objected to by many 
surgeons, have enjoyed great reputation from the most ancient to the present 
time. Pain is at once relieved. The application should, however, be continued, 
as a suspension would be followed by increased inflammation and pain, more 
agonizing than if cold had never been used. In very extensive burns, however, 
cold water is of doubtful utility, on account of its sedative effects on the al- 
ready depressed system. 

" 7. In commencing bed-sores, cold applications are usually very serviceable. 

" 8. After the operation for cataract, the constant application of compresses 
saturated with cold water has a marked effect in preventing the development of 
inflammation." 

The residue of the reports in the present volume, save one, are devoted to 
a history of the epidemic diseases of different sections of the United States, 
during the year 1851. 

The portions of the United States included in these reports are : — 

1. New Jersey, Pennsylvania, Delaware, and Maryland. 

2. South Carolina, Florida, Georgia, and Alabama. 

3. Ohio, Indiana, and Michigan. 

4. Tennessee and Kentucky. 

5. Louisiana, Mississippi, Arkansas, and Texas. 

The Committee on the epidemic diseases of New England and New York 
occupy their entire report with suggestions calculated to improve the fulness, 
accuracy, and completeness of the reports on epidemic diseases hereafter to 
be made to the Association. These suggestions are in the highest degree 



154 



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[Jan. 



judicious, and if adopted and fully carried out, would add materially to the 
interest and value of these reports. 

It is proposed that the committees for the several sections of the Union should 
be appointed for a series of years. The results of their researches would, con- 
sequently, become from year to year more valuable, and, at the conclusion of 
their term of service, a summary of these results could be made out, which 
would be of very great value to the profession. " It is obvious that compari- 
sons could be instituted between the results of different years, by a committee 
acting for the whole period, which could not be made successfully by commit- 
tees newly appointed from year to year." 

The entire series of the reports on epidemic diseases contained in the volume 
before us are of a most interesting character. They differ, it is true, in the 
quantity and exactness of the materials furnished by each, and in the care 
with which the individual facts are digested and collated. But, as they com- 
prise a history of the personal observations and clinical experience of a large 
body of the profession throughout the different portions of the United States, 
they furnish no slight an amount of practical information. 

A continuance of these reports, under the system suggested by the Com- 
mittee above referred to, will render the Association the agent for the intro- 
duction of " a grand system of observation for the whole country, in relation 
to the causes of disease, and the means of counteracting their influence, or of 
removing them." 

Many quotations might be made from the several reports before us, present- 
ing most instructive views in relation to the character and treatment of the 
prevalent diseases of the several sections of our country; but the space we 
have already occupied will oblige us to compress within very narrow limits our 
notice of this portion of the Transactions. 

Dysentery would appear to have been one of the most wide-spread of the epi- 
demics observed during the year 1851. Notices of it appear in nearly all of the 
reports before us. In New Jersey, the disease is stated to have occurred during 
protracted drought. In Hunterdon County, the disease raged to the greatest 
extent, and with the greatest malignity, on the mountains embraced within 
the bounds of the epidemic. The disease was most severe on the limestone. 
In other sections of the State, however, it is remarked that where the limestone 
beds prevail the most extensively there has been less dysentery than elsewhere. 
Reference is made to an interesting tract of country called Kittatinny, a valley 
underlaid with limestone perhaps as extensively as any other region of equal 
size in the State ; while there has been no general prevalence of dysenteric 
affections within its limits, on the hills and mountains surrounding it, which 
are formed of clay and trap, the disease has prevailed in the form of an epi- 
demic, and in some districts was unusually mortal. 

On the Eastern Shore of Maryland, dysentery prevailed as an epidemic 
during the summer of 1851, the weather being excessively hot and dry. 
The region is destitute of limestone. 

In Houston County, Georgia, epidemic 'dysentery prevailed, though neither 
extensively nor of a grave character; the temperature of the weather was 
pretty equable, and it was rather dry. 

The disease appears to have prevailed very extensively in different parts of 
Alabama, during the summer of 1851. 

" D. Gohlson writes, in regard to Autaugaville, that the place has been settled 
about eighteen months, and contains about three or four hundred inhabitants, 
many of whom are operatives in a cotton factory, and that the disease chiefly 



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prevailed among the latter class of persons. The houses of the operatives are 
closely crowded, and each dwelling has a privy, from which proceeds, during 
the warm months, an exhalation offensive even to persons passing the streets. 
That the disease, says Dr. Percival, of Lowndes County, depends on a vitiated 
state of the atmosphere I have no doubt. In August and September, Dr. Cilley 
tells us, that in the prairies of Lowndes County the disease occurred principally 
on those plantations on which, in consequence of the long-continued drought, 
the water was changed and freestone substituted for limestone water. ' Since 
the first week of April/ says Dr. Anderson, of Sumpter County, ' the weather has 
been remarkably dry and intensely hot, and traces of the disease only have re- 
mained.' But again, at a later period, the same gentleman writes : ' Since the 
cold weather of the middle of December, it seems to have disappeared from the 
neighbourhood entirely/ Dr. Mabry, of Dallas Ccunty, says, in regard to Selina, 
that there was nothing in the condition of the town that could enable him to 
account for the disease. The weather, however, during the spring and summer, 
was warm, and there were frequent changes from a high degree of heat and a 
dry state of the atmosphere to a cold and chilly dampness. Whenever these 
changes occurred, there was a remarkable increase in the disease. In many 
cases/ he continues, ' the immediate or exciting cause of the disease was the 
imprudent use of indigestible food/ &c. From Dr. Pearson, of Pickens County, 
we learn that the disease commenced in his neighbourhood immediately after 
the subsidence of the high water. ' It was conjectured by many that it origi- 
nated from the overflow, from the fact that it first made its appearance at War- 
saw, a small town on the river, some eight miles below in Sumpter County, 
which had but recently been entirely inundated, so that the earth under the 
houses was left saturated with moisture. From this point, as the radii from a 
centre, it spread around into the adjacent country. The epidemic, finally, 
without regard to localities, proved equally fearful and fatal upon the highest 
and formerly healthiest situations, impressing us with the idea that its origin 
depended more upon the condition and vicissitudes of the atmosphere than 
upon any local conditions referable to malarial origin. We noticed at the time 
of its greatest intensity a peculiar coldness of the nights, requiring protection 
from overcoat and blanket, while in the day time, such was the intensity of the 
heat, that nothing was comfortable but linen clothing. As the weather became 
more equable in its temperature, the disease became less frequent. Recently, 
since our nights have grown cooler, the disease has revisited us/ Dr. Clanton, 
of Warsaw, Perry County, where the disease prevailed with great virulence, 
says : ' Our streets were three feet deep in water on the 20th of February/ 
Dr. Bates, of Marion, Perry County, says : 'It is a difficult matter to assign any 
specific cause for the epidemic. There were not any remarkable or peculiar 
atmospheric changes noticed or assigned as being particularly favourable to 
the development of the disease; and from the fact of its general prevalence, it 
is fair to presume that the causes were unusual and inappreciable, though per- 
haps to a degree malarial/ Dr. Gordon, also, of Perry County, writes: 'I do 
not think it is worth the trouble to send you an account of the topography of 
Marion, as it obviously had nothing to do with the generation of the disease/ 
The supposed cause, says Dr. Carey, of Fayetteville, Talladega County, I set 
down to atmospherical changes. The "most sudden vicissitudes of weather, 
he continues, took place during the time of the epidemic. Dr. Taylor, of Tal- 
ladega, says, that apart from the deleterious influence of a cold, wet, and vari- 
able autumn, which followed a very dry summer, he knows of no cause that 
was calculated to engender the disease, and he thinks that, to a considerable 
extent, it was modified by malaria/' 

In Cincinnati and its vicinity dysentery prevailed to a considerable extent 
during the summer and through the month of September, 1851. Cases were 
frequent during and following the existence of cholera. Dr. Mendenhall 
remarks that its connection with cholera has, in his vicinity, been uniform, 
and leads us, he adds, irresistibly to the conclusion that they must have their 
origin in a common cause ) individual peculiarities and influences, and degree 



156 



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[Jan. 



of concentration of the cause determining the one or the other of these dis- 
eases. The majority of the cases of dysentery followed a diarrhoea, or super- 
vened in cases of cholera infantum. Excepting among children, the fatality 
was not great, recovery, in adults, taking place in nearly all cases. Its greatest 
prevalence was in districts where cholera was most common. The habits of 
life and influences predisposing, and the exciting causes seem to be similar in 
the two diseases. 

Dr. Dorsey, of Piqua, Miami County, Ohio, remarks in reference to the 
topography of the Miami Valley : — 

" The race of the country is agreeably diversified, but there are no lofty 
ranges of hills, nor are there any very extensive tracts of flat or unbroken 
ground. The banks of the streams are sandy and very fertile, while on the 
high grounds the soil is composed of more clay, with less vegetable mould. The 
whole country abounds in secondary limestone rock, underlying the clay soil 
of the uplands, and forming the channel of nearly all the creeks and rivers, and 
is exceedingly rich in fossil remains. No particular difference, the doctor adds, 
is found to exist, as a general rule, between the epidemics of the alluvial bot- 
toms and those of the uplands, though miasmatic fevers are more common in 
the former than in the latter locations. " 

In Miami County, dysentery, we are told, 

"Is a common disease, although it has prevailed but twice as an extensive 
and serious epidemic within the last eighteen years. The first was in 1835, 
and the second in 1850, yet few seasons pass in which more or less of the dis- 
ease is not found/' 

Highland County, Ohio, has its surface underlaid by those formations 
which lie between the old red sandstone and the lower silurian system. 

" The tops of the highest hills in the south-eastern part of the county are 
capped with the Waverly sandstone, which underlies the great Appalachian 
coal-basin to the east. Immediately under the sandstone lies a stratum of 
shale about two hundred and fifty feet thick, which caps some of the lower 
hills, but does not extend very far into the interior of the county. The dip of 
this stratum is to the south-east. 

"Beneath the shale lies a stratum of limestone one hundred and fifty feet 
thick, which is known among western geologists as the cliff, or cavernous lime- 
stone. This rock forms a substratum of the largest portion of the county. The 
width of surface, underlaid by it from west to east, in the south, is not more 
than eight or ten miles. But further north it widens very rapidly, and the 
whole breadth of the county at its northern side is underlaid by this forma- 
tion. 

" Below the cliff limestone there is a thick layer of blue marl. This crops 
out from under the limestone, and the lower part of it forms the substratum of 
the western and south-western parts of the county. The upper part of this 
stratum seems to have been removed by some powerful agency. 

"On Rocky Fork and Brush Creek, there appear in the marl, about one hun- 
dred feet from its top, several layers of thin silicious limestone, which among 
the inhabitants is known by the name of flagstone. The stratum is about 
twenty feet in thickness, and is probably co-ordinate with the flinty limestone 
of Adams County, described by Br. Locke. 

"In the south-western part of the county there are some layers of the blue 
limestone, which afford the only specimens of trilobites yet found in the county. 

" Drift covers the whole surface from north to south, but it is deposited 
much more thickly upon the northern than upon the southern portions. 

" In the north, the beds of the streams are in the cliff limestone, where it is 
not too thickly covered with drift. In the central parts, the blue marl forms 
their beds, and the hills upon either side, capped with limestone, are generally 
rounded at their summits, although the crags of the cliff rock maybe frequently 



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seen jutting out upon their sides, adding beauty to the landscape and the ele- 
ments of fertility to the soil. 

" Clear Creek, the northern branch of Rocky Fork, rises upon the elevated 
table-land underlaid by the cliff limestone, and, after flowing a short distance 
along its stony bed, rushes over a precipice thirty feet in depth, and falls upon 
a rocky bottom, to which it is confined for several hundred yards by high and 
closely pressing cliffs festooned with the drapery of overhanging shrubbery. 
Emerging from this canon, it reaches the blue marl, upon which it flows for 
several miles, passing through one of the most beautiful and fertile valleys in 
the State, and joins the Rocky Fork about twelve miles from its source/' 

The dysentery, we are informed, 

" Began to appear in Highland County early in June, and by the 1st of July 
was epidemic, and continued to be so throughout its western, middle, and 
northern parts. The tract of country afflicted with this epidemic extended 
from Dodsonville upon the west to Greenfield on the north-east, and was some 
six or eight miles wide. A particular locality, between the sources of Clear 
Creek and Willettsville, was most severely afflicted, scarcely a house escaping. 
The individuals who suffered from the disease were generally under the age of 
puberty, although adults did not escape. In the neighbourhood of Greenfield, 
Dr. Newcomer says, ' all ages, sexes, and conditions were equally liable.' " 

West Union, Adams County, Ohio, a village, is situated at an altitude of 
about six hundred feet above the level of low water in the Ohio River at that 
place, upon a cliff of limestone from which issue several springs, the water of 
which is strongly impregnated with lime. The soil is a loam of four feet in 
depth, having a highly ferruginous impregnation, so much so as to give it 
quite a red colour in many parts. The surface is quite rolling, and perfectly 
free from pools or stagnant water. 

Dysentery has occurred in some parts of this county for the three sum- 
mers preceding 1852, affecting children more than adults. 

In Wilmington, Clinton County, Ohio, dysentery was the prevailing dis- 
ease during the summer and autumn of 1850 and 1851. In the latter part 
of the summer of 1850, the disease occurred in a very malignant form. It 
existed to a great extent, particularly in the northern and western portions of 
Clinton County ; these portions are hilly, and limestone occurs superficially. 
It was very malignant on Todd's Fork and Cowan's Creek, branches of the 
Little Miami River. These districts were visited by cholera in the summer 
of 1849 and 1850. 

In Marietta, Ohio, dysentery, in 1851, made its first appearance on the 
elevated alluvial plain on the north, side of the village the last of June, and 
was confined to that portion of it for nearly eight weeks, when it gradually 
spread into the lower portions along the bottom lands. It spread into the 
adjacent country in September and October amongst the farmers, but seemed 
even there to be most rife in the elevated and hilly portions of the country. 
Wherever it prevailed, it was of a severe and malignant character; frequently 
proving fatal. It did not seem to be contagious, and yet it often attacked in 
succession nearly all the members of families in which it occurred. It was 
particularly fatal to young children and aged persons. 

Salem, Columbiana County, is situated intermediate between the hilly part 
of the State, bordering on the Ohio River, and the comparatively level portion 
of the country west and north of this place. The land for some miles around, 
particularly from north-east (including that lying north and west), to the 
south-west of the village, is rather level, but sufficiently rolling to be well 
drained. 

About the latter part of June, for the second time within thirty-six years, 
No. XLIX.— Jan. 1853. 11 



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[Jan. 



dysentery made its appearance in the village and surrounding country, and 
prevailed until the approach of cool weather in the latter part of September. 
Several cases of typhoid fever occurred at the same time with this disease ; 
in some instances, one portion of a family would have one of these diseases, 
and another portion the other. 

Before the latter part of August, the weather was not remarkably hot, or 
dry, or yet uncommonly wet. The months of May and June were somewhat 
colder than usual, with rather less rain than commonly falls at that season of 
the year. Although rather colder than usual, the temperature was such as 
to conduce to comfort, and, we should suppose, to general health. The 
months of July and the greater part of August were warmer, and there was 
a sufficiency of rain to bring forward vegetation, which had before been back- 
ward, but there was no remarkable variation from ordinary seasons. The 
weather, during the latter part of August and nearly the whole of Septem- 
ber, was excessively hot and dry. 

"Dysentery made its appearance in June, while the weather was cool and 
pleasant, and, except that it was increased somewhat during the hot and dry 
weather in September, it appeared to be but little affected by the change, until 
after the coming on of the fall rains and cool weather about the first of October, 
when both dysentery and fever disappeared. From this view of the subject, it 
would seem as though the state of the weather, so far as any sensible deviation 
from ordinary seasons is concerned, could not justly be regarded as the cause 
of the disease in a village and region of country which, since its first settlement 
(nearly half a century ago), has been but once before visited by this disease as 
an epidemic." 

" In regard to malaria, there was found no more cases in those parts of the 
district included in this account, which have been most subject to intermittent 
fever, than have occurred in those which have been the least so. In addition 
to this, dysentery has been very severe during the last summer, and more ma- 
lignant, in the hilly portions of country between Salem and the Ohio River, 
than in the district we have been describing, while intermittents and remittents 
are almost entirely unknown in these elevated situations. Some malarious 
districts in this county, on the other hand, have entirely escaped the disease 
during the past summer." 

In Belmont County, Ohio, bordering on the Ohio River, opposite to "Wheel- 
ing, Va. — of which the surface is very much broken by high hills and deep 
ravines, with rapid streams of water and no level or swampy land — dysentery 
did not prevail during 1851, but, in the preceding year, it occurred almost to 
the exclusion of all other diseases. 

In Indianapolis, and for many miles around, dysentery of a marked typhoid 
character prevailed during the years 1850 and 1851. 

In Richmond, Wayne Co., and its vicinity, during the month of August, 
1851, much of which was hot and oppressive, with great humidity of the air, 
dysentery prevailed. The most severe cases of the disease were observed on 
the rolling lands, eight or nine miles west of Richmond. 

Dalton, Wayne Co., is situated in the valley of Nettle Creek, having a fer- 
tile soil, productive of heavy vegetable growth. The banks of the creek are 
low, and a moderate rise of water causes an overflow, which, on subsidence, 
leaves an extensively-exposed surface, and stagnant pools, containing more 
or less decaying vegetable matter, which, together with the mill-ponds along 
the stream, contribute, no doubt, to the production of malarious diseases. In 
the valley, and west of it for some distance, there are wet lands and stagnant 
pools of water, and, during the summer and autumn of every year, intermit- 
tent diseases prevail to a great extent, while, in the hilly territory lying east of 
the valley, the inhabitants are almost wholly exempt from these affections. 



1853.] 



Transactions of American Medical Association. 



159 



In the same district, in which intermittent diseases are so common, the 
dysentery prevailed extensively during the summer and autumn of 1851. It 
commenced about the 1st of July, and ended about the 10th of September. 
The hilly regions east of the valley were exempt from the disease. The first 
part of the season, even up to the last of July, was wet, but, after that time, 
scarcely any rain fell until the 1st of November. During August and Sep- 
tember, the days were very hot, and the nights often rather cool. 

The dysentery has prevailed, more or less extensively, as an epidemic, in 
the southern part of Indiana, during the summer and fall of the last four 
years. In June, 1848, it visited the vicinity of Evansville, and was chiefly 
confined to alluvial districts. The season was unusually wet, the days warm, 
and the nights cool. During this year, children suffered but little from the 
disease. 

In August, 1849, the disease appeared again as an epidemic upon the sub- 
sidence of the cholera. It assumed a more severe character, and had a more 
extensive prevalence than in the preceding year. It was not entirely con- 
fined to the alluvial districts, but in them assumed a much more malignant 
character. Those places in which cholera prevailed most, were likewise most 
affected by this epidemic. Children were attacked equally with adults. 

In the summer of 1850, the dysentery again made its appearance, follow- 
ing the visitation of epidemic cholera. It was less malignant than in the 
preceding year. It was most severe in malarious districts. In the summer 
of 1851, it appeared again, and prevailed extensively, but divested of any 
malignancy. 

Fredericksburg, lies twenty-three miles west of New-Albany, on Blue 
River, in a portion of Indiana for the most part rather uneven. South of the 
town is a district called the " barrens/' with very little timber upon it, but 
numerous large basins containing water during the whole year. The soil of 
this region of country is black, with a subsoil of red clay. The water is im- 
pregnated with lime. Atmospherical vicissitudes are frequent, but the pre- 
vailing winds are from the south and south-west. The spring of 1851 was 
remarkable for rain previous to the month of J une, after which, the weather 
was excessively hot and dry, with only occasional showers. 

The dysentery commenced here about the 1st of June with great malig- 
nancy, attacking persons of both sexes, and of every age, occupation, and 
habit. 

The disease is supposed to have been generated by the condition of this 
region of country during the period of its prevalence. This opinion is founded 
on the fact of the wetness of the early part of the season, followed by exces- 
sive dryness and heat. The river became very low, while the numerous stag- 
nant ponds were constantly exposed to the influence of the sun's rays, without 
being entirely dried up. 

In Cold- Water, Branch Co., Michigan, the dysentery prevailed, during the 
months of July, August, and September, among persons of all ages. About 
two-fifths of the county are improved. It contains 15,000 acres of marsh, 
most of which produces grass that is cut for hay. The soil is mostly a fertile 
gravelly loam. The general surface of the country is undulating ; streams are 
not rapid, their banks are low and often overflowed. Cold- Water River 
abounds in shoals, in which there are many acres of aquatic plants. Small 
ponds or lakes are numerous, abounding in vegetation half submerged. 

" Popular opinion says that, when the water keeps high on the marshes, the 
season is uniformly healthy. This was true during the past summer. Dews 
are unusually heavy. Well-water contains lime in considerable proportion, 



160 



Review. 



[Jan. 



but is free from unpleasant taste or smell. The substratum in which water is 
found is coarse gravel. The month of June, 1851, was cold and rainy, while the 
month of August was very hot, with heavy rain. September was very hot and 
dry, but the nights were rather cool." 

A portion of Kentucky, extending from Danville to the Ohio River, and 
from Maysville to Louisville, with occasional exceptions, has for its surface 
rock the blue limestone of the carboniferous system. It is covered, to a 
greater or less depth, by a bed of clay, usually having salts of iron in combi- 
nation. This clay is covered by a layer of vegetable mould, constituting a 
soil of unrivalled fertility. The water used for drinking and cooking through- 
out this region is usually " limestone water." This applies to the counties of 
Kenton, Boone, Woodford, Scott, Oldham, Bourbon, Lincoln, and Madison. 
In Hickman, Fulton Co., the drinking-water is freestone. In many parts of 
Kentucky, the water for every purpose is obtained from cisterns; by the 
poorer classes, in some parts, river water is made use of. 

In reference to the prevalence of dysentery in Kentucky, we quote the fol- 
lowing summary from the well drawn-up report presented by the Committee 
of which Dr. W. L. Sutton, of Georgetown, was chairman : — 

"We find this disease to have prevailed at different points in Kentucky. 
Accounts have been received from Boone, Fulton, Kenton, Woodford, Madison, 
Bourbon, Oldham, Meade, and Lincoln. Several other counties are said to have 
suffered from it more or less." 

" Of the causes of dysentery your Committee have nothing new to say. The 
circumstances which for a long time have been considered favourable for 
the production of malaria were very strikingly present at Hickman and at Co- 
vington. At the former place, the great rise of the Mississippi River in June 
seems to have been the great cause of the sickness. The creeks and ravines 
were filled with back water to a very unusual degree, and were left, upon the 
subsidence of the water, covered with mud and decayed vegetable matter. The 
hot weather of July, August, and September, coming upon this state of things, 
produced an unprecedented amount of sickness. In the language of our re- 
porter (Dr. John Sutton), 'almost every one was more or less sick during the 
epidemic, and for some weeks enough well persons to attend to the sick could 
not be procured/ " 

" At Covington, the same remote causes existed in a manner equally marked. 
On the borders of the Ohio and Licking Rivers, and the bottom of Willow Run, 
from one hundred to four hundred yards wide, as also the flat ground extending 
towards Willow Run and to the Ohio River, together with the ponds caused by 
grading the streets, furnished ample sources for the elimination of noxious 
effluvia. 

" In Boone County, the causes producing the disease are not specified. It is 
noted, however, that it prevailed much worse along creeks. That portion of 
the county which borders on the Ohio River was remarkably exempt, as was 
supposed, owing to the sandy state of the soil, and its elevated position. 

" In Woodford County, the intense heat of September was considered as the 
cause, malarial exhalations being presumed to be absent. Nevertheless, the 
village of Midway, in which the disease was more severe than in any other part 
of the neighbourhood, is situated upon an elevated portion of land, and is 
bounded on the west by Lee's Branch, which has a border of wet, marshy 
ground, about fifty yards wide. 

" In Bourbon, it is said to have prevailed most in the vicinity of creeks and 
mill-dams. 

"At Covington, the disease commenced early in May, and continued to the 
15th of October. In Boone, it began on the 14th June, and lasted to the 24th 
October. At Hickman, it commenced soon after the subsidence of the J une 
freshet, probably during the first half of July, and continued until the 1st of 
October. In Woodford, there had been a few cases during the summer ; but 
on the 1st September it became epidemic, and continued so for two weeks." 



1853.] 



Transactions of American Medical Association. 



161 



Of the occurrence of dysentery in other portions of the United States during 
the year 1851, notices are scattered through the reports before us, but with- 
out any of those details calculated to throw light upon the etiology of the 
disease. We have passed over the interesting remarks on this subject em- 
braced in the report on the epidemic diseases of Pennsylvania, in consequence 
of the notice that has been given of them in our Review of the Transactions 
of our State Society at its session of 1852, contained in a former number of 
this journal ; in the reports there contained the same series of epidemics being 
described as in the report to the National Association. 

The reports we are now considering, present very decided evidence of the 
increased prevalence of typhoid fever in almost every portion of the Union- 
It is true that only within a few years past the attention of physicians has been 
directed to the pathological characters of this form of fever, and it has come 
to be recognized as a distinct disease. A more correct diagnosis in reference 
to it being now generally adopted may account, in part, for the more frequent 
notice of it than formerly as an endemic of the United States. Still, we 
believe it will be found true that it has become actually a more common dis- 
ease. In some districts of country typhoid fever would appear indeed to have 
superseded in a great measure the former endemic fevers of an intermittent 
and remittent type. This has been strikingly the case throughout the State 
of Pennsylvania. At the same time there would appear to have taken place 
a decided change in the character of nearly all diseases — they have become 
less sthenic — less acute. Active and direct depletion would appear to be less 
frequently indicated, and when resorted to, to produce more rapid and exten- 
sive prostration than formerly, while a more general and speedy resort to 
stimulants and tonics would seem to be demanded. 

During the year 1851, scarlet fever appears to have prevailed over a large 
extent of the United States, varying in different sections and localities in ma- 
lignancy — in some being attended with but little danger, while in others it has 
been particularly uncontrollable and fatal. 

Erysipelas has also prevailed throughout the United States, during the 
period embraced in these reports to an unusual extent, assuming at many 
points the characteristics of a genuine epidemic. A most interesting account 
is given by Dr. Z. Pitcher, of an epidemic of this character which prevailed 
in Detroit, Michigan, in the year 1847, and again occurred in May, 1851, and 
extended over other portions of the State. 

Repeated mention is also made of the occurrence of epidemic parotiditis 
at different points, and likewise of the occasional appearance of jaundice as 
an epidemic. 

It would extend this notice to a most unreasonable length, were we to 
attempt to notice all the points of interest and importance embraced in the 
reports before us. We shall refer to only one or two more additional parti- 
culars. 

Following the report which includes an account of the epidemics of South 
Carolina, Florida, Georgia, and Alabama, is a table by Dr. Wm. M. Boling, 
of Montgomery, Alabama, presenting a view of the form, type, character, 
duration, and result of 1035 cases of periodical fever, which occurred in his 
practice from the first of June, 1843, to the last day of May, 1848 : together 
with the age, sex, and colour of the patients, and the months in which the 
cases occurred; and their locality, whether in city or country. We view this 
as a most valuable document; it presents, at one glance, all the leading facts 
connected with the disease to which it relates. To wade through the details 
of the same number of cases, when given in the form of even general his- 



162 



Review. 



[Jan. 



tories, would be a labour which few would undertake, while it would scarcely 
afford, with equal certainty, the same amount of useful information as may be 
gained by a simple inspection of these tables. 

The report of Dr. Fenner, on the epidemics of Louisiana, Mississippi, Ar- 
kansas, and Texas, presents some interesting facts in relation to the sanitary 
aspects of those States, and of their different sections. He has carefully 
digested into tables that portion of the recent national census relating to the 
mortality of these States ; the diseases being classified according to the plan 
adopted by Dr. J. C. Simonds, and the results of these as indicating the sani- 
tary condition of particular sections, illustrated by a series of coloured maps. 
Though not convinced of the entire accuracy of the census returns of deaths 
throughout the United States, yet, as approximating to the truth, and certainly 
affording some general indication of the more common of those diseases by 
which life is shortened, they are not without their value. 

The comparison furnished in this report of the relative mortality of Missis- 
sippi, Arkansas, Louisiana, and Texas, with that of England, and the table 
exhibiting the total amount and percentage of mortality from various dis- 
eases in each of the four States above named, and in Mexico, Havana, four 
rural districts of Cuba, Maryland, and the City of New Orleans, are curious 
and instructive, supposing them to be founded on reliable statistics. 

We should have felt strongly inclined to copy this portion of Dr. Barton's 
report, had we not already extended our notice of the present volume of Trans- 
actions to what may perhaps be esteemed an unreasonable length. 

The concluding report is from the Committee on Indigenous Medical Botany 
and Materia Medica for 1850-51. It presents a synopsis or systematic cata- 
logue of the indigenous and naturalized flowering and filicoid medicinal 
plants of the United States, with their localities, botanical and medical refer- 
ences, and a short account of their medicinal properties. It was prepared by 
Dr. A. Clapp, of Indiana, Chairman of the Committee. It evinces great indus- 
try on the part of its author, and will be found extremely useful for future 
reference. D. F. C. 



1853.] 



163 



BIBLIOGRAPHICAL NOTICES. 

Art. XIII. — Clinical Reports on Continued Fever, based on an Analysis of One 
Hundred and Sixty-Four Cases, &c. By Austin Flint, M. D., Buffalo, 1852: 
8vo. pp. 390. 

The papers composing this volume were originally published in the Buffalo 
Medical Journal, during the last three years, and are now presented, without 
change, in a more accessible form. They are amongst the most elaborate and 
satisfactory contributions to the medical history of the diseases which they 
treat of that have been published in the United States, and entitle their author 
to a distinguished position among the medical pathologists of the country. In- 
deed, we cannot recall any other instance of equally industrious and enlight- 
ened zeal for original observation amongst the native writers of our profession. 
It might be imagined in so new a country, in the absence of established and 
authoritative medical institutions, with our national fondness for novelty, our 
indomitable eagerness to discover and pursue new paths, our national acuteness 
of intellect, and our unrestrained competition for the vantage-ground of public 
applause and reward, that more energy would be directed to original researches, 
and more discoveries in science made, than where custom and authority are 
supposed to be paramount, and settled opinion is thought to have the force of 
law. But the reverse of all this is plainly the fact. Whether constrained 
thereto by a law of human intelligence which obliges the less skilled to borrow 
the lights of more accomplished nations, or whether diverted from scientific 
culture by the urgent claims of practical wants, or swept along by the swollen 
tide of utilitarianism, which allows no one to stand still either to contemplate or 
expound the laws of phenomena that are most fitted to attract attention and 
arrest inquiry, it cannot be denied that we have sacrificed too much and too 
long the artist to the artisan, and the philosopher to the practitioner. Doubt- 
less, in some departments of knowledge, we have begun to recognize the higher 
aim, and have made noble efforts to pursue it. Every year the scattered and 
formless elements assume more and more determinate shapes, and we may 
detect in them the germs and nuclei of future discoveries of truths which shall 
take their place as permanent portions of the great structure of knowledge. 

Among the examples of successful inquiry in the field of American medi- 
cine, none is more remarkable than the one before us. The reader may 
trace in it the gradual education of the author's mind to a rigorous system 
of inductive reasoning, and watch the interesting progress of a sincere, but at 
first, an ill-assured effort to extract the laws of diseases from a classification 
of their phenomena. The first of the three series of cases which the author 
submitted to analysis presents a somewhat defective arrangement, and the 
comparison of examples which a more prolonged habit of observation proved 
to belong to different categories. In the second series, a more assured and 
penetrating analysis discloses more distinctly the diversity of type of at least 
two of the classes which furnish the materials for the series. In the third, the 
truth at last stands fully revealed, and there is no longer any doubt as to the 
diversity between the two principal diseases, typhus and typhoid fever, which 
had formed the chief subjects of inquiry. This gradual and progressive ad- 
vancement towards a conclusion which in the end bears all the marks of a 
demonstrated problem, is one of the most convincing proofs of its harmony 
with truth, and of the candor with which the investigation was prosecuted. 

By the arrangement of the matter here described, each series of cases super- 
sedes to a certain extent the previous one. Indeed, each succeeding one was 
published for the purpose of perfecting the conclusions already reached, and 
correcting the errors into which a limited experience had led the author. 



164 



Bibliographical Notices. 



[Jan. 



But this circumstance renders it impossible to give our readers an abstract of 
the work. It is to be hoped that when new materials in sufficient number shall 
have been collected, the author will unite them, with what he has already pub- 
lished, in a systematic treatise, which shall contain distinctly the ultimate con- 
clusions he may then have reached. Such a work would, we have no doubt, 
be heartily welcomed by the profession. 

We had marked a number of passages for comment; but finding that several 
of the statements in them were materially modified by the author after more 
ample experience, we thought it but just that his opinions should not be too 
critically judged in their present form. In the treatment of typhus and typhoid 
fever, the author does not appear to have deviated very materially from the 
most approved methods, his management of the former disease being chiefly by 
stimulants, and of the latter by stimulants and such means conjoined with 
them as seemed needed to meet special indications. The employment of dif- 
fusible stimuli in typhoid fever is very probably required more frequently than 
writers of the Parisian school advise ; but it is certainly an exaggeration of 
their necessity to speak of their use in continued fever, without specifying which 
of the types they are best adapted to cure. In typhoid fever, they are some- 
times indeed necessary, especially when the patients are of feeble constitution, 
or have indulged habitually in alcoholic drinks ; but as a general rule, this 
disease runs its course with fewer accidents when they are withheld. Typhus, 
on the contrary, calls for diffusible stimuli almost from the start, and he would 
be a bold man, indeed, who should attempt to combat the malady without them. 

Dr. Flint made some experiments with quinia, vith opium, and with the wet 
sheet as employed by the hydropathists. The first had no appreciable effect 
upon the disease. The second, he thinks, " does, in large doses, in some cases, 
possess more or less power to affect the progress of continued fever. He pre- 
scribed as much as four grains at a dose. The few cases he reports scarcely 
sustain this opinion. Of more than one of them, too, the diagnosis is very 
doubtful. The use of the wet sheet seems to have been profitable in several 
instances, by reducing the temperature of the skin, the frequency of the pulse, 
and the febrile delirium. But it does not appear to have been systematically 
employed, and further experience of its good effects would be needed to recom- 
mend it. 

The author gives a succinct history of several cases of " doubtful type," 
among which, as well as among those contained in the body of his essay, there 
are some which we take to have been instances of simple continued fever. 
This is, undoubtedly, an independent disease, distinguished chiefly by its sud- 
den onset, its short course of seven or eight days, and its rapid convalescence. 
It is very often mistaken for typhoid fever of a mild type. 

Still other cases are included by the author amongst those of typhus and 
typhoid fever, which he finally recognizes as examples of what has been de- 
nominated relapsing fever. It acquires this name from the circumstance that 
convalescence apparently takes place between the fifth and the tenth day, and 
yet, after an interval of from five to eight days, another attack occurs, and is 
frequently preceded by a chill. The second attack is equally severe with the 
first, if not more so, but generally terminates in cure. Sometimes, however, a 
third, and even a fourth relapse has been observed. The disease is seldom fatal ; 
and when death does take place from some accidental cause, no characteristic 
lesion is discovered. 

The concluding paper of the volume before us treats of the contagious cha- 
racter of typhoid fever, as illustrated by the occurrence of the disease in Erie 
Co., New York. The facts here related demonstrate the possibility of the 
disease being propagated by contagion, and go to strengthen the conclusion 
which had already been reached by Louis and other continental observers. As 
this writer remarks, it is only in the dissemination of the malady in country 
places that its contagiousness becomes manifest, for there only can the commu- 
nication of persons with the sick and with one another be clearly traced. At 
the same time, it must be admitted to be less generally contagious than the 
eruptive fevers, properly so called, although like them it would seem to be ren- 
dered more or less transmissible by inappreciable causes. A. S. 



1853.] 



Piper, Operative Surgery Illustrated. 



165 



Art. XIV. — Operative Surgery Illustrated: containing more than nineteen hun- 
dred Engravings ; including two hundred Original and Jiffy Colored Drawings, 
with Explanatory Text. By R. U. Piper, M. D. Also, a Chapter upon the 
Use of Ether in Surgery, from the Transactions of the American Medical 
Association, written at the request of a Surgical Committee of that body, by 
Henry J. Bigelow, M. D., Professor of Surgery in the Medical School of 
Harvard University. Boston : Ticknor, Reed, & Fields, 1852 : 8vo. pp. 384. 

Publications upon operative surgery have been very abundant of late, in 
every language which boasts of possessing a medical literature. Some have 
been limited to certain specialities, others have been general in their applica- 
tion. In this country alone, the number of treatises on general operative sur- 
gery, published within an inconsiderable lapse of years, is not small. We can 
enumerate, as having come within the limits of our own observation, Mott's 
edition of Velpeau\s valuable work; Pancoast's Operative Surgery: Malgaigne's 
excellent book, translated by Brittan, and reprinted in this city ; Dr. Smith's Expo- 
sition of American Operative Surgery, just issued ; and the translation of the vo- 
lume of Bernard & Huette, now in process of publication in New York. Besides 
these, there are several valuable treatises on the Practice of Surgery, including 
the operative branch of the science, which have been reprinted from foreign ori- 
ginals — as Liston's, Fergusson ; s, Miller's, Druitt's, Skey's, Pirrie's, Bransby 
Cooper's, &c. &c, and others emanating from American authors, e. g. Hast- 
ings's Surgery. 

The appearance, therefore, of another book upon this subject, is a matter for 
gratulation or otherwise, according to its intrinsic and peculiar merits ; for, 
under the circumstances, it cannot certainly be supposed to be needed. In this 
light, we propose to examine Dr. Piper's book. 

The text consists of explanations of, or comments upon, the plates ; sometimes 
a few words suffice to explain the latter ; sometimes, as in the description of 
important operations, several pages are thus occupied. Generally, the author 
uses his own language; occasionally, the text is marked as a quotation. 

As is usual in works of this kind, many of the plates are devoted to repre- 
sentations of the various instruments used in surgical operations, and the man- 
ner in which they are employed or applied. It would be entirely unnecessary, 
and perhaps impossible, to figure and describle all the instruments and imple- 
ments which have been introduced into the armamentarium of surgery ; and 
Dr. Piper does not attempt to do this. His selections have been made from the 
most approved French, English, and American patterns, and are, as a general 
rule, judicious. 

The ninth plate, and the accompanying explanatory remarks, refer to the vari- 
ous kinds of suture, to the application of adhesive strips, and to " Mr. Fergus- 
son's knot for strangulating tumours with broad bases.' - ' Plates tenth and 
eleventh show the veins and arteries of the different regions in which phlebo- 
tomy and arteriotomy are most commonly practised, and the mode of perform- 
ing these operations: 

The succeeding plates, to the seventeenth inclusive, exhibit the main arteries 
of the different regions, at the points ordinarily selected for the ligature of these 
vessels. Some of these drawings, though small, are sufficiently well executed to 
be of assistance to the operator ; others, again, exhibit so little of the relational 
anatomy of the bloodvessels as to be of no use whatever. 

Plates eighteen and twenty-one represent the ligaments of the joints. The 
views of the male and female axillee, the surgical dissection of the axillary and 
brachial regions, and that of the arm and forearm, which are given in plates 
nineteen and hoenty, seem somewhat out of their proper place; they would na- 
turally appear in connection with others which relate particularly to the blood- 
vessels; but as now located, they inflict a violent separation upon the two plates 
first enumerated, which should be studied together. The pictures here intro- 
duced of the axillary regions are decidedly the best in the book, especially the 



166 



Bibliographical Notices. 



[Jan. 



first of the twentieth plate. They are evidently copied from Maclise ; yet Dr. 
Piper fails to acknowledge their parentage, though he has done this with refe- 
rence to some other drawings taken from the source just named. 

The plates intervening between the twenty-first and the sixty-third are chiefly 
illustrative of the various amputations and resections. Many of these operations 
are described at length ; others are merely indicated by the names of their sug- 
gestors. Interspersed among them are drawings of tumours, of caries and 
necrosis of bone, of violent injuries to the limbs, &c, for which amputation was 
performed in individual cases; and there are also a few delineations of trephin- 
ing and other operations upon the cranium and the face. 

The operations figured in the succeeding plates, as far as number 95, are 
numerous and varied, but are not arranged in any very convenient or definite 
order — those of the same kind and for the same affection being often scattered 
about as if accidentally. Among them may be mentioned operations for the 
removal of the upper and lower jaw, the clavicle, the breast, the parotid gland, 
and tumours of various regions ; operations upon the larynx, trachea, and oeso- 
phagus; for harelip, and fissures of the palate; for club-foot, and other distor- 
tions; rhinoplastic operations; paracentesis of the chest, abdomen, and scro- 
tum. 

Next to these, wounds of the abdomen, with and without concomitant injury 
to the intestines, are depicted, together with many of the plans of treatment 
recommended therefor. (Plates 95 and 96.) 

The varieties of hernia are exhibited in the following eight plates (97 to 104 
inclusive), with the accident which sometimes follows this affection, artificial 
anus. The drawings are generally well executed, and the explanatory remarks 
are unusually full, as compared with those appended to the representations of 
some other important surgical maladies. But neither in the drawings, nor in 
the descriptions of the operation's, and other mechanical modes of treating 
hernia, do we find anything new, or anything which may not be more profit- 
ably sought for in most of the ordinary treatises upon the practice of surgery. 

The succeeding seven plates exhibit operations upon the anus and rectum, 
and the external genito-urinary organs of the male, the instruments employed, 
and some of the diseases affecting these parts. 

Calculus — the operations performed for its removal from the bladder and 
urethra, and the instruments by which these are accomplished — constitutes the 
subject of the plates from No. 117 to 130 inclusive, with the exception of a few 
drawings which have been carelessly thrown from their proper position; e. g. 
an illustration of M. Keybaud's instrument for removing pus from the pleural 
cavity, and of a canula for the rectum. 

Dislocations and fractures are next exemplified in the plates from No. 131 to 
160 inclusive. The figures are taken chiefly from the works of Sir Astley 
Cooper, Mr. Liston, Mr. Fergusson, and Mr. Druitt. 

Plates 161 and 162 contain illustrations of numerous bandages. 

Diseases of and operations upon the eye and its appendages are exhibited in 
the ten plates next succeeding, together with a great variety of instruments 
for their treatment. 

Plates 173, 4, 5, 6, 7, represent additional varieties of club-foot, and other 
congenital and acquired distortions, with some of the mechanical contrivances 
employed to overcome them. Here again we have an instance of the want 
of arrangement, so far at least as we can judge, which frequently shows 
itself in this volume ; for, in plates 65, 6, 7, and 8 are drawings of similar 
deformities. The 178th plate exhibits illustrations of vesico-vaginal and recto- 
vaginal fistula, and of lithotomy in the female ; and the question very naturally 
presents itself, would it not have been better to group these with the similar 
operations practised upon the male, which are represented in plates 105-108 ? 

The 179th plate is devoted to representations of instruments used for cupping 
and scarifying, for cauterizing, and of different kinds of moxa. 

The implements employed in the extraction of teeth are shown in the 180th 
plate. 

On the 181st and 182d plates are portrayed an example of rupia, various 
forms of aneurism in different situations, effects of wounds upon arteries, a 



1853.] 



Report on Quarantine and Yellow Fever. 



167 



case of carbuncle, one of fungus hseniatodes, and an abscess of the oesophagus 
communicating with the aorta. 

The subject of the next plate is the celebrated case reported in this journal, 
for July, 1850, by Dr. Bigelow, of Boston, in which an iron bar was forced 
through a man's cranium without fatal consequences. 

The 184th exhibits a case of necrosis of the humeral bone, of excision of the 
lower jaw, of paronychia, and fragments of necrosed bone. 

The 185th exemplifies the operation of ligatures applied for popliteal aneur- 
ism ; a case of the same affection cured by the application of ice ; and the 
" articulation of the ankle bones, with reference to the amputation through the 
tarso-metatarsal articulation." 

The 186th and last plate exhibits the efficacy of adhesive strips as a means 
of extension in fracture of the femur; "and a case of a patient of the author 
whose finger was torn off by machinery/' It will be observed that the subjects 
of the last six plates have all been previously depicted, and their value has 
been in some measure diminished by not being introduced in proper connec- 
tion. 

We have thus presented our readers with a sort of Table of Contents of this 
volume, in order that they may see the amount and the arrangement of the 
readable and pictorial matter therein contained. 

As to the real value of Dr. Piper's book, its capability of supplying a want 
in one's library, our readers may judge from the sketch we have presented. 
The author has undoubtedly laboured assiduously, and, we may add, success- 
fully, to accumulate a great variety and number of drawings to illustrate most 
of the diseases and injuries which surgeons are called upon to treat ; and he has 
accompanied the figures with verbal descriptions of different methods of per- 
forming the more important operations. But we really cannot perceive that 
the book possesses any advantage over the standard illustrated treatises on the 
Practice of Surgery which are now generally accessible to the profession and 
to students, and, as a reliable authority, it seems to us to be inferior to most of 
them. The text contains nothing which may not be better obtained from the 
sources just referred to; the drawings are generally copied from these (very 
many of them being thus appropriated without the slightest acknowledgment 
on the part of the author), and, are certainly not better, or more expressive, 
than the wood-cuts, with which several of the more recent of them are illus- 
trated; and the want of system in the general arrangement of the materials 
will, we should suppose, render it a very inconvenient book of reference. 

F. W. S. 



Art. XV. — Second Report of the General Board of Health on Quarantine, 
yellow Fever. Presented to both Houses of Parliament, by command of Her 
Majesty. London, 1852: 8vo. pp. 414. 

Appendix (C) to .the Report of the General Board of Health on the Epidemic 
Cholera of 1848 and 1849. Abstract of Report, by James Wynne, M. D., on 
Epidemic Cholera, as it prevailed in the United States, in 1849 and 1850. Pre- 
sented to both Houses of Parliament, by command of Her Majesty. London, 
1852: 8vo. pp. 93. 

Further Observations on that portion of the Second Report on Quarantine by the 
General Board of Health, which relates to the Yellow Fever Epidemic on Board 
Her Majesty's Ship Eclair, and at Boa Vista in the Cape Be Verde Islands: By 
J. 0. McWilliam, M. D., F. R. S., R. N., Medical Inspector of Her Majesty's 
Customs. London, 1852: 12mo. pp. 40. 

The report of the General Board of Health of Great Britain on the subject 
of Quarantine, especially in reference to Yellow Fever, is a document of the 
deepest interest to the physicians of our own country, in many parts of which 
the disease continues to occur, if not as an annual, at least as a not unfre- 
quent epidemic ;, while the commercial intercourse between our principal ports 



168 



Bibliographical Notices. 



[Jan. 



and those within the yellow fever regions, renders the subject of its origin 
and mode of propagation one of vital importance. The question of the conta- 
giousness of yellow fever is examined in the report before us, not only with re- 
ference to the facts, of a negative character, that have been recorded by the' 
best and most authoritative observers, but also in reference to those which have 
been adduced in proof of the affirmative of the question, at different periods, by 
physicians who have observed the disease in various countries. All the facts 
necessary to the formation of a correct conclusion appear, indeed, to have been 
sedulously sought after by the Board, and their true value and relationship 
carefully and candidly examined. The whole of these facts, it is clearly shown 
in the report before us, prove the origin of the yellow fever, in every instance, 
from local morbific causes, and the impossibility of its propagation, under 
any circumstance, by a contagious matter or miasm generated by the disease 
itself ; consequently, the insufficiency and inutility of quarantine regulations 
to prevent its introduction into any place, or to arrest its spread in those local- 
ities where it prevails. This is precisely the same conclusion at which the 
most eminent of our own physicians, who are conversant with the disease 
have arrived, and it is, most unquestionably, the correct one. But while no 
good can result from a quarantine of persons coming direct from places where 
yellow fever is prevailing, or even of those actually labouring under the dis- 
ease, we are not persuaded that it is perfectly safe to allow vessels from sickly 
ports, or on board of which disease of a malignant character has made its ap- 
pearance during the voyage, to enter a port, and land their cargoes in the 
midst of a populous community. Disease we have known to be in this manner 
introduced into our own city. So far as relates to a detention of such vessels 
at a proper distance from the port, until they shall have undergone a thorough 
cleansing and ventilation, we believe that quarantine regulations are useful ; 
farther than this, our experience, acquired during many years service as a mem- 
ber of the Philadelphia Board of Health, has taught us such regulations, ex- 
cept in the case of smallpox, are not only useless, but positively injurious. 

An enumeration of the several particulars, discussed in the report before us, 
will give to our readers a general idea of the leading positions which the facts 
presented are presumed to establish. We give this enumeration, alone, from 
our inability to do entire justice to the report excepting by a series of extracts, 
the length of which would extend our present notice to a most unreasonable 
length. 

" Resemblances between yellow fever and cholera. Yellow fever not trace- 
able to contagion. Sporadic cases. Seclusion affords no protection. Advan- 
tages of a removal from infected localities. Non-transmission of yellow fever 
to other patients in hospitals. Comparative mortality in different localities, 
showing the presence of the localizing conditions: of overcrowding ;' of filth; 
of want of drains, and bad drains ; of dampness, swamps, and marshes ; yel- 
low fever capable of being produced by these causes." An examination is 
entered into of the more prominent of the alleged cases of importation, viz. : 
The " Hankey," at Grenada, 1793 ; the " General Elliott/' at Martinique, 1796; 
the "Dolphin/' at Cadiz, 1800; the " Transports," at Gibraltar, 1810; the 
"Fortune," at Gibraltar, 1813; the "Grand Turk," at Barcelona, 1821; the 
"Bann," at Ascension, 1825 ; the "Dygden," at Gibraltar, 1828; the "Growler," 
at Barbadoes, 1847 ; the " Tentadora" and "Duarte," at Oporto, 1851 ; and the 
" Eclair," at Boa Vista, 1845. 

The examination of these several instances in which the yellow fever is pre- 
sumed to have been introduced by infected vessels and crews, will convince 
every candid mind that the evidence by which the fact of the importation of the 
disease in either case, save the last, is supposed to be established, is, to say the 
least of it, small in amount, and doubtful in quality. We except the case of 
the " Eclair," because, after a careful and impartial examination of all the evi- 
dence that has been presented in relation to the circumstances attending the 
arrival of this vessel at Boa Vista with fever on board, and the appearance 
immediately after the landing of a portion of her sick crew upon the island, of 
the same fever, among the inhabitants, and its subsequent spread from individ- 
ual to individual, has convinced us that, if it be possible to prove the importa- 



1853.] 



Report on Quarantine and Yellow Fever. 



169 



tion of any disease, Dr. McWilliam has done so in relation to the fever in ques- 
tion. We have, ourselves, no belief in the contagiousness of yellow fever. 
Our views in relation to the etiology of the disease; our prejudices, if we have 
any, are decidedly opposed to the doctrine of importation, but we cannot reject 
the conclusive evidence adduced by Dr. McWilliam, in proof of the introduction 
of fever into Boa Vista by an infection derived from the sick landed there from 
on board the Eclair : evidence, that has been in no degree invalidated by the 
counter reports which have been made in reference to the fever in question. 
We have our doubts, it is true, as to the fever, thus introduced, being actually 
yellow fever ; but whether it was so or not, we coincide fully with Dr. McWil- 
liam in the following statement made by him, near the close of his "Observa- 
tions' ; on that portion of the Report of the General Board of Health, which 
relates to the case of the Eclair: — 

"In my humble opinion, the history of the epidemic at Boa Vista compre- 
hends every condition upon which the proofs of the infectiousness of a disease 
are supposed to rest, namely: — 

" The healthiness of the island before the arrival of the Eclair, with fever on 
board. 

" The outbreak of the same disease among the inhabitants of the island, 
within a reasonable period afterwards. 

" The immunity of distant villages for long periods until after the arrival 
there of infected persons, and the radiation of the disease in every district from 
infected foci. 

" The comparative immunity from the disease obtained by persons who 
adopted common but partial precautionary measures against infection. 

"The absolute immunity from the disease procured by persons who adopted 
strict measures of isolation and segregation/ 5 

In the " Observations" referred to, Dr. McWilliam points out a number of 
misstatements which occur in the Report of the General Board of Health, in 
relation to some of the important points connected with this subject. 

The following are the general conclusions at which the Board of Health have 
arrived from a consideration of the evidence respecting yellow fever presented 
in the report before us: — 

" 1. That yellow fever epidemics break out simultaneously in different and 
distant towns, and in different and distant parts of the same town, often under 
circumstances in which communication with infected persons is impossible. 

" 2. That yellow fever epidemics are usually preceded by the occurrence of 
individual or sporadic cases of the disease, which sporadic cases are likewise 
common in seasons when no epidemic prevails. 

" 3. That yellow fever epidemics, though occasionally extending over large 
tracts of country, are more frequently limited as to the space over which they 
spread, often not involving the whole of a town, and, sometimes, not even any 
considerable district of it. 

" 4. That yellow fever epidemics do not spread from district to district by 
any rule of gradual progression, but often ravage certain localities, while they 
spare entirely, or visit very lightly, others in the immediate neighbourhood, 
with which the inhabitants are in constant intercommunication. 

"5. That yellow fever epidemics, when they invade a district, do not spread 
from the houses first infected to the next, and thence to the adjoining, and thus 
extend as from a centre ; but, on the contrary, are often strictly confined to 
particular houses in a street, to particular houses on one side of a street, to 
particular rooms in the same house, and often even to particular rooms on the 
same story. 

" 6. That, in general, when yellow fever breaks out in a family, only one or 
two individuals are attacked, commonly the attendants upon the sick escape ; 
and when several members of a family are successively attacked, or the attend- 
ants on the sick suffer, either the epidemic was general in the locality, or the 
individuals attacked had gone into an infected district. 

" 7. That when yellow fever is prevalent in a locality, the most rigid seclu- 
sion in that locality affords no protection from the disease. 

" 8. That, on the other hand, so great is the success attending the removal 



170 



Bibliographical Notices. 



[Jan. 



from an infected locality, and the dispersion of the sick in a healthy district, 
that by this measure alone the further progress of an epidemic is often arrested 
at once. 

u 9. That such dispersion of the sick is followed by no transmission of the 
disease, not even when the sick are placed in the wards of a hospital among 
patients labouring under other maladies. 

" 10. That no one of the preceding facts can be reconciled with any other 
conclusion than that, whatever may be the exciting cause of yellow fever, it is 
local or endemic in its origin ; and the evidence of this conclusion is, there- 
fore, cumulative. 

" 11. That the conditions which influence the localization of yellow fever are 
known, definite, and, to a great extent, removable, and are precisely the same 
as the localizing causes of cholera and of all other epidemic diseases. 1 

" 12. That, as in the case of all other epidemic diseases, in proportion as 
these localizing causes are removed or diminished, yellow fever ceases to ap- 
pear, or recurs at more distant intervals, and in milder forms. 

" 13. That, besides the common external localizing causes, there is one con- 
stitutional predisposing cause of paramount importance, namely, non-acclima- 
tization, that is, the state of the system produced by residence in a cold climate; 
in other words, European blood exposed to the action of tropical heat; the prac- 
tical lesson being, that the utmost care should be taken to prevent individuals 
or bodies of men, recently arrived within the yellow fever zone, from going 
into a district in which the disease actually exists, or has recently been pre- 
sent. 

" 14. That the means of protection from yellow fever are not quarantine re- 
strictions and sanitary cordons, but sanitary works and operations, having for 
their object the removal and prevention of the several localizing conditions, and, 
when such permanent works are impracticable, the temporary removal, as far 
as may be possible, of the population from the infected localities." 

The abstract of a report by Dr. James Wynne, on epidemic cholera, as it pre- 
vailed in the United States in 1849 and 1850, printed as one of the appendices 
to the Report on Cholera of the General Board of Health of England, presents 
a very succinct but truthful outline of the leading facts having a direct bearing 
upon the etiology of epidemic cholera observed during the prevalence of that 
disease in this country during the years indicated. 

We present the concluding remarks of Dr. Wynne ; not that we can subscribe 
to them, when carried out to the full extent they admit of, but because we be- 
lieve that they are strictly true in their application to the etiology of the dis- 
ease which is the immediate subject of Dr. Wynne's report. 

" In all these circumstances, the adjuncts in the production of cholera are 
found to maintain a striking resemblance to those which produce malarial dis- 
eases. If the question was propounded to me, After the collection of all these 
facts, can you tell what is the nature of the cause that produces cholera? I 
should, unhesitatingly, reply that I could not. But I should give the same an- 
swer if I were interrogated concerning the nature of autumnal fever. It is 
true, I might reply in regard to fever, that it depended upon the presence of 
malaria. But what is malaria? It is the decomposition, under certain circum- 
stances, of vegetable matter. These circumstances are, the presence of air, 
heat, and moisture. Whenever these elements unite in due proportion, fever is 
produced, but if either be wanting, malaria is not generated. Hence, during 
the cold of winter and the dryness of mid-summer we have no fever; but with 
the decomposed vegetation of autumn, united with the heat and moisture of 
that season of the year, fevers prevail. Heat and moisture cannot produce 
fever ; it requires decomposed matter, uncleanliness, and filth. These are pre- 
cisely the circumstances under which cholera makes its appearance, and the 
reader will have had frequent occasion to observe how much it is under the 
conjoint influence of elevated temperature and moisture, and how steadfastly 
it dwells among filth and uncleanliness. 

" I do not assert that the cause of autumnal fever and cholera are identical ; 
but I do aver that the whole history of the epidemic, as it prevailed in the 



1853.] 



Simon's Lectures on Pathology. 



171 



United States, proves that it cannot exist in the absence of those conjoined ele- 
ments known to produce fever; and no facts more fully substantiate this posi- 
tion, than those connected with its prevalence at the Baltimore Almshouse, and 
its absence in the city as an epidemic. No person will fail to recognize, in the 
filthy condition in which this establishment was kept, a sufficient cause for dis- 
ease, and no one can doubt the influence it exercised over the spread of cholera 
in this immediate locality. 

"If this position be fully substantiated, have we not the means in our own 
hands of arresting its desolating ravages? Does not this disease present itself 
as a teacher as well as a scourge? Every one must admit the justice of the 
following observations of Professor Caldwell: 1 Cholera, though a fatal scourge 
to the world, will, through the wise and beneficent dispensation under which 
we live, be productive of consequences favourable alike to science and human- 
ity. Besides being instrumental in throwing much light on" the practice of 
physic, it will prove highly influential in extinguishing the belief in pestilen- 
tial contagion, and bringing into disrepute the quarantine and sanitary esta- 
blishments that have hitherto existed/ " 

D. F. C. 



Art. XVI. — General Pathology, as conducive to the establishment of Rational 
Principles for the Diagnosis and Treatment of Disease. A Course of Lectures, 
delivered at St. Thomas's Hospital during the Summer Session of 1850. By 
John Simon, F.R.S., one of the Surgical Staff of that Hospital, and Officer 
of Health to the City of London. Blanchard & Lea : Philadelphia, 1852 : 
8vo. pp. 211. 

These twelve lectures present a more interesting and instructive exposition 
of the leading principles of general pathology, as deduced from the best authen- 
ticated series of observations, and the facts that have been developed by the 
application of chemical analysis and microscopic investigation to the study of 
disease, than many treatises that have been published upon the same subject, 
of greater bulk and pretensions. 

The lectures are written in a familiar but clear and pleasing style. If we 
were disposed to find any fault with them, it would be that they are too con- 
cise; or, perhaps, to speak more correctly, there is too much important matter 
crowded into too small a space. There is, in fact, scarcely one of the lectures 
but contains sufficient materials for a volume equal in size with the one before 
us. The conciseness of manner with which the important questions embraced in 
these lectures are discussed by Dr. Simon, produces, it is true, neither obscurity 
nor confusion in his teachings ; it taxes, however, to a great extent, the at- 
tention of the reader, while the true value of the doctrines advanced, and 
their relations to the diagnosis and treatment of disease, are less readily per- 
ceived than would have been the case had a few more sentences been occupied 
in their exposition. 

We have been particularly pleased with the lecture on scrofula, and that on 
morbid poisons. The views advanced in the first of these lectures strike us as 
being those which best accord with what we know of the particular circum- 
stances under which tubercular disease develops itself; for, with Dr. Simon, we 
believe that all those affections to which the term scrofulous is properly appli- 
cable are to be considered as one or other of the forms of tuberculosis; they 
accord, likewise, with the symptoms and course of the disease, and the facts 
developed in relation to it, by the researches of the pathological anatomist; it is 
these views which, in our opinion, can alone form the basis of a successful plan 
of preventive or curative treatment. 

Were we to discuss with the lecturer the question of tuberculosis, in all its 
bearings, we should find occasion, on one or two points, to question the correct- 
ness of the conclusions at which he has arrived. 



172 



Bibliographical Notices. 



[Jan. 



We admit with him that tubercular matter is a morbid exudation from the 
blood or lymph ; that it has its rise in a diseased condition of the blood, and 
that this diseased condition of the blood is one affecting its development. We 
believe that the vessels which furnish the materials of this exudation are in a 
state of hyperemia or stasis ; that although tuberculous deposits cannot be 
strictly said ever to be the product of inflammation, yet every cause calculated 
to retard the circulation of the blood through an organ promotes the deposit in 
that organ of tuberculous matter, and hence it is that pulmonary tuberculosis 
is most common in those climates in which bronchitic and pulmonary inflam- 
mation are of frequent occurrence. Tubercular phthisis may effectually destroy 
the structure of the lungs and cause the death of the patient without the occur- 
rence of inflammation. 

We have strong doubts whether tubercular matter possesses, of itself, any 
tendency to become softened; with Professor Kostlin, of Stuttgart, we believe 
that this softening is always determined by a serous fluid derived from the ves- 
sels by which the tuberculous deposits are surrounded. 

We recommend to our readers, nevertheless, an attentive study of Dr. Simon's 
lecture on scrofula. We hesitate not to say that from it they will derive more 
correct views of the general pathology of tuberculosis than from any source with 
which we are acquainted. 

We had marked one or two paragraphs from the lecture on morbid poisons, 
in order to show the very ingenious and plausible views of the author in refer- 
ence to the principle of infective disorders in the human subject; but as these 
extracts are somewhat long, and from a work that, from its intrinsic value, 
and the cheap form in which it is presented by the American publishers, cannot 
fail to find a place upon the reading-table of every student, we refrain from 
presenting them, believing they will be read, and with more interest and profit, 
in connection with the other portions of the lecture of which they form a part. 

D. F. C. 



Art. XVII. — Reclierches sur la Locomotion du Caiur. Par A. A. Verneutl, 
Doeteur en Medecine, etc. etc. Paris, 1852: 4to. pp. 58. An Inquiry into 
the Locomotion of the Heart. By A. A. Verneuil, M.D. 

It is not our intention, in noticing the very able inquiry of Dr. Verneuil, pre- 
sented as his thesis for the degree of Doctor in Medicine to the Faculty of Medi- 
cine of Paris, to enter into an examination of the correctness of the views he 
has advanced, or to test the truth of the anatomical exposition upon which 
those views are based; we leave this to such of our readers as can command 
the requisite time and opportunities for the work. Our object, on the present 
occasion, is simply to present some account of the conclusions at which the 
author has arrived, and, in so doing, our labour will be chiefly confined to a 
translation of his language into English. 

The locomotion of the heart, remarks Dr. Verneuil, so often verified, and by 
such various means, has become one of the best-established facts in physiology. 
This locomotion is composed of several successive acts, which we will now pass 
in review. During the ventricular systole, the base of the heart remaining 
immovable, or nearly so, its point approaches the latter, and, at the same 
time, it is carried forward on the side of the anterior face of the ventricular 
mass, which incurves itself in »uch a manner as to present a plane surface, or, 
according to some authors, a curvature with an anterior concavity ; the ventri- 
cular mass executes, also, another movement, in consequence of which its 
point, at the same time that it rises, is carried from left to right in describing 
the slight arc of a circle, combined with a sort of rotation upon the supposed 
axis of the heart. These movements are so combined as to constitute one of a 
spiral character. 

During the diastole, the heart resumes its primitive position ; the ventricular 
mass becomes lengthened, and dilates, especially towards its anterior part. 



1853.] Yerneuilj Inquiry into the Locomotion of the Heart. 173 



The heart seems to unroll itself. Its point, as it removes itself from the base, 
describes a spiral motion from right to left, at the same time it is depressed, and 
conceals itself, if we may be allowed the expression, in the depression on the in- 
ternal face of the left lung. 

During the systole, the form of the ventricles is variously modified. We 
observe : — 

1. The shortening of the ventricular mass ; 2, the flattening or incurvature 
of its anterior face ; 3, a swinging motion, in consequence of which the point 
becomes more salient; 4, a twisting or spiral motion from left to right, upon 
the longitudinal axis of the ventricular mass, in consequence of which the left 
extremity of the heart (the point) approaches the median line, while the right 
extremity of the ventricles (the base of the right ventricle) is depressed, and 
is seemingly carried slightly backwards ; 5, the base of the left ventricle 
remains nearly immovable. 

In the diastole, the ventricles, distended by the blood, resume their primi- 
tive form and position, in undergoing changes directly the reverse of those just 
described. 1. The ventricular mass augments in volume, the point is removed 
further from the base and from the anterior face of the ventricular mass. 2. 
The point swings backwards, redescends, and sinks towards the spine. 3. It 
describes the arc of a circle from right to left. 4. The base of the right ven- 
tricle becomes more salient in front. 

Such is the locomotion of the heart, which is produced by the organ itself, 
for, when the heart of an animal is removed from the body, and placed upon a 
table, we observe it still to contract, and become modified in its form ; but, in 
this experiment, as M. Beau has well observed, many of the movements enume- 
rated above do not take place; among others, all the movements that have been 
indicated as occurring during the diastole. 

The heart, in fact, still contracts, and becomes condensed; but when the con- 
traction ceases, its muscular fibres relax, and the heart becomes soft and flac- 
cid, but it does not dilate ; its contraction, even, does not proceed in the same 
manner as when it is distended by the blood during the diastole. M. Beau has 
with propriety, therefore, objected to the explanation of the normal mechanism 
of the heart from the phenomena observed when that organ is laid upon a table. 
M. Verneuil goes even still further, and maintains that, in relation to the locomo- 
tion of the heart, we cannot compare what takes place in an animal or in man, 
when the parietes of the thorax are intact, with what we observe in a foetus 
affected with prtesternal ectopia, or in an animal whose pericardium has been 
laid open, even when care has been taken to leave the pleuras in their normal 
condition. When, he remarks, the thorax is in its ordinary state, the point of 
the heart, instead of having a tendency to approach or strike against the pari- 
etes of the chest, strives, as it were, to quit these during the systole, elevates 
itself, and reaches the level of the fourth rib. The dissections that M. Yerneuil 
has made, as well as the attentive consideration that he has given to the dis- 
tribution of the muscular fibres of the heart, have convinced him, even in the 
absence of vivisections, that in the normal systole the point of the heart ascends 
from left to right; but, without being carried either forwards or backwards, it 
follows simply the posterior surface of the anterior thoracic parietes. 

In the state of repose, the point of the heart corresponds most generally to 
the level of the fourth intercostal space, or at the most to the level of the fifth 
rib with its cartilage ; now, as during the systole, the apex of the heart is ele- 
vated ; it is impossible for it, therefore, to strike against the chest on a level 
with the fifth or even the sixth intercostal space ; that is to say, one to three 
finger-breadths lower than the spot where the apex of the heart is found when 
in a state of repose. In making the impulse of the heart to coincide with its 
systole, we shall find a difficulty, also, in explaining how it is frequently so 
distinctly felt at the epigastrium. 

In his second chapter, M. Yerneuil enters into a detailed examination of the 
locomotion of the heart and of the question immediately resulting from it, the 
cause of the heart's impulse against the thoracic parietes. He passes in review 
the opinions of the leading authors who have treated on these subjects, and 
then remarks that the locomotion of the heart is so intimately connected with 
No. XLIX.— Jan. 1853. 12 



174 



Bibliographical Notices. 



[Jan. 



the stroke of the ventricular mass upon the parietes of the chest, that most 
observers, and particularly the more recent, have occupied themselves entirely 
with a consideration of the latter phenomena — the prgecordial impulse. En- 
chained by the results of experiments which they have not taken the trouble 
to repeat, they take it for granted that it is during the ventricular systole that 
the impulse of the heart against the chest takes place. A great number of 
authors whose good sense taught them that it must be at the moment when the 
heart is increased in its length and breadth that it imparts a shock to the 
thoracic parietes, admit the coincidence between this shock and the systole of 
the ventricles, but very reluctantly, knowing that the heart during its systole be- 
comes shortened. They find themselves surrounded by these three difficul- 
ties : — ■ 

1. The base of the heart is immovable, and serves as a 'point d'appui. 

2. The apex approaches the base ; while at the same time, 

3. The apex is carried in a contrary direction towards the walls of the thorax 
against which it strikes. 

In place of at once leaping over the barrier which impedes their approach to 
the truth, rather than reject the authority of Harvey and of Haller, they have 
endeavoured to discover some especial cause by which the movement of the 
heart at the same time from and towards the anterior walls of the chest could 
be explained. They have accordingly had recourse to a change in the curva- 
ture of the aorta and pulmonary arteries at their origin from the heart; to the 
diastole of the auricle and its impulse against the vertebral column; to the 
auriculo-ventricular reflux; to the impulse resulting from the return of the 
column of blood to the auricles. No one of which can be established as the 
cause of the prsecordial shock. 

They have adopted, in the absence of any better, the opinions of Ferrein and 
of Senac, to which Haller in some measure submits; but he, in common with 
many of the modern physiologists, reserves for himself an escape by the admis- 
sion that the arrangement of the muscular fibres of the heart may, in fact, be 
in part the cause of its impulse against the chest. 

In alluding to the fact that Galen had shown that the heart, detached from 
the body, still pulsated — which is mentioned by every writer on the subject — a 
fact which proves incontestably that the movements of the heart are produced 
solely by the action of its own muscular fibres — M. Yerneuil remarks, that the 
error into which physiologists have been led, notwithstanding their familiarity 
with this, is pardonable, inasmuch as, although the heart, when it is laid bare, 
is shortened during the systole, its apex is at the same time carried forward. 
Hence it was a natural conclusion, that its impulse against the anterior walls 
of the chest occurred during the systole. It was not considered that, when the 
thorax is laid open, the heart is no longer in the same condition as it is when 
the thorax is in its normal state, any more than the lungs are when the pleurae 
are laid open ; that a certain portion of the anterior surface of the heart can 
never be removed from their contact with the inner face of the anterior pari- 
etes of the chest; that it cannot alternately approach and recede from these, as 
it does when the pericardium is opened ; that there is never any empty space 
within the cavity of the latter so long as the thorax is intact; and, consequently, 
that the conditions necessary for an impulse of the heart against the thoracic 
parietes do not exist, but only for the simple movement of sliding from above 
downwards, and from right to left during the diastole, and in the opposite 
direction during the systole. It has not been remarked, further, that the im- 
pulse of the apex of the heart takes place between the fifth and sixth ribs, and 
extends downwards, while the apex of the heart during the systole, on the 
contrary, is elevated to a point corresponding with the fourth intercostal space, 
on a level with the junction of the fourth rib and its cartilage ; that the impulse 
should extend upwards, if it was effected during the ascending movements of 
the heart ; and that the heart cannot attain the sixth intercostal space unless 
violently distended. 

M. Verneuil refers the locomotion of the heart solely to the arrangement of 
the muscular fibres of the organ itself. He remarks, that the systolary move- 
ments are not merely fortuitous and without utility ; on the contrary, they were 



1853.] 



Verneuil, Inquiry into the Locomotion of the Heart. 



175 



necessary in the human subject, at least, in consequence of the position of the 
heart, and its relation to the other viscera contained within the thoracic cavity. 

In proceeding to describe the locomotion of the heart from the arrangement 
of its muscular fibres, M. Yerneuil remarks, let us suppose, at first, to simplify, 
that the heart is placed vertically, and we find that: — 

"1. The right ventricle is not upon the same plane as the left; it is placed 
upon a higher plane, and while the latter forms almost the entire apex of the 
heart, the former projects considerably at the base of the organ. In the early 
period of utero-gestation, the two ventricles have nearly the same length, and 
are situated side by side. It would seem that subsequently the two ventricles 
experience a lateral gliding motion upon each other, by which the left descends 
towards the apex, while the right mounts towards the base. This comparison, 
it is true, is altogether ideal ; it is simply presented to explain the change that 
the different development of the two sides of the heart has produced in the rela- 
tive position of the ventricles. Thus the right ventricle has passed before and 
to the right of the left. The infundibulum contributes in a great measure to 
augment the height of the left ventricle anteriorly. 

" 2. It hence results that the anterior face of the heart represents a scalena 
curvilinear triangle, of which one side is formed by the left edge of the heart 
— this is the shortest, and appertains to the left ventricle; — another side is 
formed by the right edge of the heart — it is the longest, and appertains to the 
right ventricle ; — the third side corresponds with the base of the ventricular 
mass. 

" 3. The inferior or posterior face of the heart, on the contrary, represents, very 
nearly, an isosceles triangle, of which the base corresponds to the base of the 
ventricular mass ; that is to say, to the inter-auriculo-ventricular depression. 
The left side of the triangle is formed by the left ventricle, and the right side 
by the right ventricle. These two sides are almost equal ; because the right 
ventricle, being carried more forwards, takes, relatively, less part in the forma- 
tion of the inferio-posterior face of the heart. 

" 4. The anterior face of the ventricular mass is higher in front than behind ; 
this excess in height is the greatest, however, at the right portion of the ante- 
rior face of the organ, on a level with the infundibulum of the right ventricle." 

In regard to the structure of the heart, M. Verneuil remarks : — 

*.* This organ is composed of several planes of muscular fibres. 

" 1st. The superficial unitive fibres, common to the two ventricles. 

" 2d. The curved or looped fibres, proper to each ventricle. 

" 3d. The deep-seated fibres of the ventricles, constituted in great part of the 
deep-seated branches of the curved or looped fibres, of which the superficial 
branches are simply the unitive fibres already noticed. 

" Notwithstanding the greatly varied directions of the muscular fibres of the 
heart, these directions may all be classed under three general heads : — 

" 1st. Perpendicular fibres, or very nearly perpendicular to the axis of the 
ventricles. 

" 2d. Parallel fibres, or very nearly parallel to this axis. 

"3d. Fibres whose direction is neither perpendicular nor parallel to the axis 
of the heart, but intermediate to both. 

" 4th. Spiral fibres, which have a special action hereafter to be described." 

" The ventricles, as we observe, are in great part formed of complete muscular 
loops, which, proceeding from the muscular zones of the base of the heart, 
return to these, after having been, at first, superficial, and then deep-seated. 
The term superficial unitive fibres is applied to the first half of these loops, 
extending from the fibrous zones of the base to the apex of the heart; here they 
form a vortex, changing their name and direction ; from descending, they be- 
come ascending; from superficial, profound; and proceed to form the fleshy 
columns of the internal parietes of the ventricles, and then return to their 
point of departure; that is to say, to the fibrous zones of the base of the heart. 
Whether their direction be sinuous or rectangular; whether they be in the form 
of the figure 8, or of simple loops ; whether their deep-seated portion belongs 
to the interventricular partition, or to one or other of the parietes of the heart, 
it is incontestable that the same fibre forms invariably a loop, more or less open 



176 



Bibliographical Notices. 



[Jan. 



or closed, of which the two ends are inserted in the fibrous zones of the base of 
the heart, and of which the free and convex portion corresponds with the apex. 
It is equally evident that this loop has its point d'appui at the insertion of its 
two extremities, and that its shortening can act only upon the convex or free 
portion of the loop. From this it follows that every contraction of one of these 
loops parallel to the axis of the heart can produce no other effect than to ap- 
proach the apex towards the base. In this exposition, there is nothing new; 
but I must recall it to memory, although it has been repeated a thousand times, 
when the object is to prove that the heart becomes shortened during its systole. 
Let us take a very simple example : The cremaster muscle is formed of large 
muscular loops with their concavity above, of which the two ends are attached 
and take their point d'appui upon the spine of the pubis within, and upon the 
crural arch without. When the loops contract, the integuments to which they 
adhere are thrown into transverse wrinkles, and the testicle embraced within 
their concavity is drawn towards the abdominal ring. This example applies 
very well to the fibres proper to each ventricle, which are simple loops arranged 
the one above the other, or which represent, according to the expression of M. 
Gerdy, cornets inserted one within the others. 

" The preceding exposition is applicable to the fibres of which the direction 
is parallel, or nearly so, to the axis of the heart ; but dissection shows that 
many of the fibres are almost perpendicular to this axis. These contribute 
but little to draw the apex towards the base ; but their action is to cause the 
parietes of the ventricular cavities to approach their axis. 

" A kind of antagonism has been imagined to exist between the fibres parallel 
to the axis, or the longitudinal fibres of the heart, and the transverse fibres, or 
those perpendicular to that axis ; hence the famous hypothesis, again and again 
overthrown, but as repeatedly resuscitated, that certain fibres of the heart con- 
tract during the diastole, while others contract during the systole. This ques- 
tion is now decided. 

" There does not exist in the heart vertical rectilinear fibres, nor fibres that 
are exactly circular and horizontal in reference to the axis of the organ. The 
same fibre may in its course be in one part longitudinal, and in another trans- 
verse ; an arrangement which is met with in all those regions of the body where 
the muscular fibres are considerably intricated, as, for example, in the lips, 
perineum, uterus, &c. In the heart, one set of fibres, at one point, by their 
action draw the apex of the organ towards its base, while at another they cause 
a contraction of the ventricular sac. Each loop, also, may effect two distinct 
movements of the heart. Take, for instance, a vertical loop ; its branches 
have the same convexity as have the parietes of the heart. Now, every curved 
muscle in contracting has a tendency to become rectilinear; hence, at the same 
time that the apex of the heart approaches the base, the parietes of the organ 
are brought nearer to the axis. This explains the utility of the inward cur- 
vature of the base of the ventricles on a level with the auriculo-ventricular 
furrow, by its increasing the length and convexity of the fibres. 

" Let us suppose a muscular loop nearly perpendicular to the axis of the 
heart; its two points of insertion will be in the fibrous zones at the base of the 
organ, and, consequently, more elevated than its middle portion; so that it will 
present a convexity towards the apex of the heart as well as towards its exterior 
surface. In contracting, this loop will have a tendency to become rectilinear, 
and consequently will produce a twofold effect — that of shortening the heart, 
and, at the same time, contracting its cavities. 

" A word or two now in regard to the spiral fibres. More than one author 
has invoked their aid to explain the locomotion of the heart. How does a 
spiral fibre act in contracting ? Let us suppose it to be fixed at only one of its 
extremities ; its contraction will have a tendency to cause its free extremity to 
approach the point of insertion, while the cylinder or hollow cone that it forms 
tends to contract so as to cause the parietes to approach the axis. Finally, it 
impresses upon its movable extremity a centrifugal rotatory motion. The sterno- 
mastoideus muscle, which is but slightly spiral, nevertheless in contracting 
turns the entire head. Let us choose another example. Take a twisted and 
vertical cord, fixed at its extremity to a horizontal bar; wet the cord, and it will 



1853.] Yerneuil, Inquiry into the Locomotion of the Heart. 177 



contract ; the bar, at the same time, 'will mount towards the point d'appui in de- 
scribing the arc of a circle of more or less extent. It is easy to apply this 
in explanation of the spiral fibres of the heart. A muscular fibre is entwined 
around the ventricular cavity, having its fixed point at the base, and its free 
extremity at the apex of the heart : in contracting, it presses upon the movable 
parietes of the cavity it surrounds, and consequently tends to approximate 
them ; it therefore contributes to the contraction of the ventricle, while, at 
the same time, by drawing the apex towards the base of the heart, it tends to 
shorten the organ, and, finally, it communicates to it a rotatory motion, by 
causing the whole of the ventricular mass to turn upon its axis." 

Dr. Yerneuil, after presenting some diagrams tending to illustrate the simple 
and conjoint action of the muscular fibres of the heart, remarks : — 

" Without any geometrical demonstration, it is easy to comprehend that when 
two muscular fibres, similar in their action and power, but of unequal length, 
act simultaneously, the absolute contraction of the one having the greatest 
length will exceed that of the shorter fibre; and, consequently, if these two 
fibres are inserted at an angle into a movable point, the longest of the fibres 
will draw that point towards the side on which it is inserted. If, then, we find, 
in the heart of man and the inferior animals, that the muscular fibres are 
longer upon one of its faces than upon the other, its apex will be necessarily 
drawn on that side during the ventricular systole. Such, in effect, is the case, 
and hence nothing is more clear than the theory of the systolar locomotion of 
the heart." 

M. Yerneuil proceeds next to show the inequality of the muscular fibres of 
the heart at different points. 

" 1st. The longest fibres are the superficial unitive fibres of the anterior face 
of the organ. They are almost parallel to the axis of the ventricles ; their 
fixed point of insertion is at the anterior part of the right auriculo-ventricular 
orifice, and in passing over the infundibulum describe a very considerable curve, 
which augments much their length. They surround the infundibulum and the 
right anterior portion of the base of the heart; from thence they pass to the 
anterior-ventricular parietes, over, for the most part, the anterior-interventri- 
cular depression, covering the anterior surface of the left ventricle, and arriv- 
ing at the apex of the heart they become reflected, and penetrate almost com- 
pletely in the opening which is left below by the proper fibres of the left ven- 
tricle, and finally, after being, towards the apex of the heart, twisted into the 
form of the figure 8, they become deep-seated, and constitute the profound fibres 
of the aortic ventricle, returning from thence to the aortic or left auriculo-ven- 
tricular fibrous zones. These form, therefore, a complete, almost vertical loop, 
of which the superficial branch, which belongs especially to the right ventricle, 
is incontestably much longer than the deep-seated branch. Besides, these super- 
ficial unitive fibres represent the fibres in the form of the italic S, or spiral, 
directed from the right to the left, and from above downwards, participat- 
ing in the character both of the fibres parallel to the axis and the spiral fibres. 
They have a mixed action, as already indicated. 

" 2d. At the posterior face of the heart, the superficial unitive fibres are 
much less marked. They are inserted at the posterior demi-circumference of 
the left auriculo-ventricular orifice, and descend towards the apex. A number 
of these fibres do not quit the left ventricle, and becoming reflected near the 
apex of the heart, pass to the anterior parietes of the same ventricle, forming, 
consequently, simple postero-anterior loops, of which the anterior branch is 
the longest. 

"Another part of these unitive fibres pass over the posterior interventricular 
depression, arrive at the apex of the right ventricle, become there curved, and 
penetrate into its depths, forming the fleshy columns of this ventricle. These 
posterior unitive fibres are much less numerous than those of the anterior sur- 
face. They affect, also, the spiral form, but in a degree much less decided." 

On removing these unitive fibres, we find fibres, of which the direction is 
almost circular in the upper two-thirds of the ventricular mass. These fibres 
arise from the pulmonary and aortic orifices, the right and left auriculo-ventri- 
cular orifices. Those of the anterior face of the heart are very much curved, 



178 



Bibliographical Notices. 



[Jan. 



and consequently have considerable length; their direction is from left to right, 
almost perpendicular to the axis of the right ventricle, the convexity of which 
they embrace as circular fibres; then, passing over the right border of the 
heart, they arrive at its posterior face, pass the posterior depression, until they 
reach the left ventricle, when they incline towards the apex of the heart, and, 
assuming a spiral form, they are reflected to form the profound ascending fibres 
of the parietes of the left ventricle, and of the interventricular partition. 

" The fibres which arise especially from the orifices of the left chamber of 
the heart remain in great part confined to the left ventricle ; some, however, 
pass onwards to form the profound fibres of the right ventricle. 

" Finally, the ventricles have each their proper fibres : these are disposed — 
1st, in vertical loops, with the concavity presenting upwards, of which one of the 
limbs is exterior and descending, the other interior and ascending; they form 
arcades, or a species of rings lengthwise with the internal surface of the ven- 
tricles : 2dly, in loops almost circular, which serve as sphincters to the auriculo- 
ventricular, pulmonary, and aortic orifices." 

The functions of the several sets of muscular fibres entering into the struc- 
ture of the heart are thus explained by M. Verneuil: — 

" 1st. The base of the heart being supposed to be immovable, or nearly so, 
the shortening of the ventricular mass is due to the action of the superficial 
unitive fibres of the anterior and posterior faces ; to the action of the profound 
fibres which form the vertical fleshy columns, and the interventricular partition, 
and to the action of the muscular loops proper to each ventricle; in a word, to 
all the fibres, muscular loops, and fleshy columns which are more or less paral- 
lel to the axis of the ventricles. 

"2d. The deviation of the apex of the heart from the anterior face: the 
flattening of this face of the heart is produced by the action of these same 
fibres, which are longer upon the anterior than they are upon the posterior 
parietes. 

" 3d. This deviation of the apex anteriorly is, therefore, as Hope, Parchappe, 
and Berard had suspected, inherent in the anterior parietes of the heart. A 
case of ectopia, which was observed by M. Follin, has given to this opinion 
absolute confirmation. 

" 4th. The spiroid movement of the heart is due to the spiral fibres. The 
tendency to this movement is in two opposite directions ; the deep-seated spiral 
fibres of the left ventricle tend to produce a movement from right to left; and the 
superficial spiral fibres from left to right ; the latter, being the most numerous, 
counteract the tendency of the former, and, consequently, the heart moves 
spirally in the direction impressed upon it by them. 

" 5th. The movement of the heart in the arc of a circle, from left to right, 
and from above downwards, is intimately connected with the spiral movement; 
it is due more especially to the action of the anterior superficial unitive fibres, 
of which the length is so considerable. These fibres act by their middle por- 
tion as the vertical fibres, by their inferior portion as the spiral fibres, and by 
their superior portion as the circular fibres : they thus contribute to produce 
the depression of the base of the right ventricle. 

" 6th. As all these longitudinal fibres are, also, more or less spiral or curved, 
with the concavity of the curves directed towards the axis of the ventricles, they 
in contracting tend to assume a straight direction, and, consequently, contri- 
bute to the contraction of the ventricular cavities. 

" 7th. The contraction of the transverse diameter of the ventricular cavities 
is especially due to the transverse or circular fibres ; but as these fibres always 
incline from the base towards the apex of the heart, they concur also in pro- 
ducing the shortening of the heart and in its spiroid movement. 

" 8th. All the fibres are synergic, all contract simultaneously, and concur each, 
to a certain extent, to the accomplishment of the appreciable acts of the systole ; 
shortening of the heart, contraction of its cavities, deviation of the apex up- 
wards and from the right side forwards ; a spiroid movement, or in the arc of a 
circle from left to right; and, finally, depression of the base of the heart." 

D. F. C. 



1853.] 



Harris, Dental Surgery. 



179 



Art. XVIII. — Principles o f Human Physiology, with their Chief Applications to 
Psychology, Pathology, therapeutics, Hygiene, and Forensic Medicine. By W. 
B. Carpenter, M. D., F. R. S., F. G. S., Examiner in Physiology and Compa- 
rative Anatomy in the University of London, &c. &c. Fifth American from 
the Fourth and enlarged London Edition. With three hundred and fourteen 
Illustrations. Edited, with additions, by Francis Gurney Smith, M, D., 
Prof, of the Institutes of Medicine in the Medical Department of Pennsyl- 
vania College, &c. Philadelphia: Blanchard & Lea, 1853: 8vo. pp. 1091. 

This volume reached us at so late a period, that we have been unable to pre- 
pare a full notice of it for our present number, and must, therefore, postpone 
to a future occasion an examination of its particular merits. We may now 
state, however, that the present edition has been entirely remodelled, so that in 
reality it may be considered as a new work. 

The principle which the author has adopted throughout " has been that of 
making the Treatise express his present convictions and opinions, as completely 
as if it had now been for the first time put forth ; the old materials having been 
incorporated with the new, rather than the new with the old ; and having only 
been employed, where they could be readily made subservient to this purpose. 
In making his selection from the vast mass of results which have been recently 
accumulated by the diligent labours of physiologists of various countries, the 
author has been guided by the principle which he expressed in the preface to 
his previous edition; — that, namely, of not rashly introducing changes incon- 
sistent with usually received views; — nor, on the other hand, showing an un- 
willingness to reject the statements of those who have taken adequate pains to 
arrive at accurate conclusions. ' He trusts that he may be found' — now as 
then — 'to have exercised a sound discretion, both as to what he has admitted, 
and what he has rejected; and that his work will appear to exhibit, on the 
whole, a faithful reflection of the present aspect of Physiological Science/ " 

To untiring industry in making himself acquainted with the experiments 
and observations of other physiologists and a sound appreciation of the facts 
of the science, Dr. Carpenter has the faculty of clearly and perspicuously pre- 
senting his own conclusions, which have made the previous editions of this 
work highly popular, and will secure for the present one the character of being 
the most complete work on the science in our language. 



Art. XIX. — The Principles and Practice of Dental Surgery. By Chapin A. 
Harris, M. D., D. D. S., Professor of the Principles and Practice of Dental 
Surgery in the Baltimore College. Fifth edition, with two hundred and 
thirty-six Illustrations. Philadelphia: Lindsay and Blakiston, 1853: pp. 812. 

This work has run rapidly to its fifth edition, indicating its popularity with 
the profession, and proving, at the same time, the improvement and upward 
tendency of dentistry in the country. The book contains ample evidence of 
faithful and able authorship. From the table of contents we select the general 
titles, for the purpose of showing the scientific method and comprehensiveness 
of the work. They are such as these : Anatomy and physiology of the mouth ; 
dentition, first and second; irregularity of the teeth, its treatment; deformity 
and partial luxation of the jaw. 

Peculiarities in the formation and growth of the teeth ; osseous union of 
the teeth ; third dentition. These topics are briefly but successfully treated, 
and well illustrated. 

Physical characteristics of the human teeth and gums ; the salivary calculus ; 
the lips and tongue, and the fluids of the mouth; diseases of the teeth, and 



180 



Bibliographical Notices. 



[Jan. 



their treatment; dislocation of the lower jaw; diseases of the gums and alveo- 
lar processes, and their treatment; diseases of the maxillary sinus, and their 
treatment; mechanical dentistry ; diseases and defects of the palatine organs. 
The improvements in this edition are three new chapters on mechanical den- 
tistry, thirty-five additional engravings, and a general revision of every chapter. 

The author has availed himself of the best authorities in the anatomical 
department, and has carefully brought up the body of the work to the present 
state of improvement and discovery in practical dentistry. Indeed, for ful- 
ness, variety, usefulness, and effective array, the author may justly claim the 
highest praise from the students and practitioners of the profession. In respect 
to the details in the department of mechanical dentistry, we do not assume to 
speak with authority; but we are assured by gentlemen in the profession that 
it is ably executed. Of those parts of the work which are common ground for 
all the divisions of the healing art we may speak more confidently, and we do 
most cordially testify our approbation of the work. 

We have very frequent occasion to notice the zeal, ability, and success which 
the cultivators of dental science are manifesting in the improvement of their 
profession. Dr. Harris's last publication is a new and gratifying instance of 
this general advancement. The whole profession seems to be animated with 
the laudable ambition of excellence. Their colleges are rapidly increasing in 
number, and as rapidly rising in rank and value, and general surgery and me- 
dicine will soon have reason to be proud of the achievements of their younger 
sister, who is pushing her claims, on the solid ground of worthiness, with such 
energetic earnestness. Dentistry, as yet, has been only borrowing the discoveries 
of the older branches and appropriating them to its use ; but it bids fair now to 
repay its indebtedness to the common stock. Our best surgeons find great ad- 
vantage in consulting dentists in the treatment of diseases which fall within 
their specialty, and their publications are every day growing richer in materials 
and hints capable of improving our text-books in surgical and medical practice. 
In this judgment of the works on Dentistry which are now issuing from the 
press, we are fully sustained by our fellow-journalists. We recommend our 
readers to give them a place in their libraries, and due consideration in their 
professional studies. E. T. 



Art. XX. — Quarterly Journal of Microscopical Science, including the Transac- 
tions of the Microscopical Society of London. Edited by Edwin Lankoster, 
M. D„ F. R. S., F. L. S. ; and George Busk, F. R. C. S. E., F. R. S., F. L. S. 
No. I., October, 1852; with four lithographic Illustrations. 

We hail with pleasure the appearance of this new Journal, which promises 
to furnish important contributions from a field of science in which a rich har- 
vest is to be gathered by the industrious cultivator. Each number will contain, 
first, the Transactions of the Microscopical Society, and which will be paged 
separately; and, secondly, the Journal. This last will contain, first, original 
contributions on subjects requiring elucidation by the microscope ; and upon 
those relating to the structure of the instrument itself. Second, translations 
and abstracts of papers in foreign journals, with illustrations. Third, critical 
notices of books of interest to the microscopist. Fourth, microscopical notices, 
and memoranda, and correspondence. Fifth, proceedings of local microsco- 
pical societies. 

The first number contains many valuable papers, and in our Summary we 
shall notice such as more particularly interest us as medical practitioners. 



1853.] 



181 



QUARTERLY SUMMARY 

OF THE 

IMPROVEMENTS AND DISCOVERIES 

IN THE 

MEDICAL SCIENCES. 



ANATOMY AND PHYSIOLOGY. 

1. Defence of the Doctrine of Vital Affinity, against the Objections stated to it 
by Humboldt and Dr. Daubeny. By Dr. Alison. — The object of this paper was 
to fix attention on the great physiological discovery which has been gradually 
effected during the present century, of the mode in which certain of the ele- 
ments contained in the earth's atmosphere, under the influence of light and of 
a certain temperature, are continually employed in maintaining that great vital 
circulation, of which vegetable structures, animal structures, the air, and the 
soil, are the successive links; and to point out that the most essential and fun- 
damental of the changes here effected — particularly the formation of the differ- 
ent organic compounds in the cells of vegetables — are strictly chemical ' changes, 
at least as clearly distinct from any chemical actions yet known to take place 
in inorganic matters, as the vital contractions of muscles are distinct from any 
merely mechanical causes of motion; and justifying the statement of Dr. Dau- 
beny, that there appears to be "a power, residing in living matters/' and pro- 
ducing chemical effects — in fact, manifesting itself most unequivocally by the 
chemical changes which result from it — "distinct, at least in its effects, from 
ordinary chemical and physical forces." 

But, after having made this statement, Dr. Daubeny, according to the author 
of this paper, has thrown a degree of mystery over the subject which is quite 
unnecessary and even unphilosophical, by refusing to admit — and quoting 
Humboldt, who has changed his opinion on the subject, and now likewise de- 
clines to admit — that these changes are to be regarded as vital; both authors 
(as well as several other recent English authors) maintaining that, as we do 
not know all the conditions under which ordinary chemical affinities act in 
living bodies, we are not entitled to assert that these affinities may not yet be 
found adequate to the production of all the chemical changes which living 
bodies present; and that, until this negative proposition is proved, it is unphilo- 
sophical and delusive to suppose the existence of any such power as that to 
which the term Vital Affinity has been applied, by the author of this paper, and 
several other physiologists. 

In answer to this, it is here stated, that as we cannot, strictly speaking, define 
Life, or Vitality, we follow the strict rules of philosophy, in describing what we 
call living bodies, whether vegetable or animal, and then applying the term 
Vital, or living, as the general expression for everything which is observed to 
take place only in them, and which is inexplicable by the physical laws, de- 
duced from the observation of the other phenomena of nature; that, according 
to this, the only definition of which the term vital admits, or by which the ob- 
jects of Physiology can be defined, Dr. Daubeny has already admitted, in the 
expressions above quoted from him, that chemical as well as mechanical changes 
in living bodies, fall under the denomination vital; and as the rule of sound 



182 



Progress of the Medical Sciences. 



[Jan. 



logic is " affirmantibus incumbit probatio," and, as it is just as probable d priori, 
that, with a view to the great objects of the introduction of living beings upon 
earth, the laws of chemistry, as those of mechanics, should be modified or sus- 
pended by Almighty Power, this author maintains that we are as fully justified 
in referring all great essential chemical phenomena, which are peculiar to liv- 
ing bodies, to peculiar affinities, which we term vital, as Haller was to ascribe 
the peculiar mechanical movements of living bodies, to the vital property of 
Irritability; and to throw on the mechanical physiologists of his day the bur- 
den of proving, if they could, that the laws of motion, perceived in dead 
matter, were adequate to explain them. 

In illustration of the importance, both in Physiology and Pathology, of this 
principle being held to be established, Dr. Alison adduced two examples, first, 
the utter failure of the very ingenious theory of Dr. Murray to explain, on 
ordinary chemical principles, the simplest and most essential phenomena of 
healthy Secretion; and, secondly, the now generally admitted inadequacy of any 
theory of Inflammation, which does not regard a modification of the affinities 
peculiar to life, and here termed vital, as the primary and essential change, in 
the matter concerned in that process. — Proceedings of the Royal Society of Edin- 
burgh, Session 1851-52. 

2. Contributions to the Physiology of Vision. — On some remarkable and 
hitherto unobserved phenomena of Binocular Vision. By Charles Wheat- 
stone, F. R. S. — This paper is a continuation of the memoir presented by 
Professor Wheatstone to the Royal Society in 1838, and published in the 
" Philosophical Transactions" for that year ; in which he first announced his 
very remarkable discovery, that the notion of solidity or relief which we derive 
from the direction of the visual sense to solid bodies, is essentially dependent 
upon the reception and combination by the mind of two dissimilar perspective 
views projected upon the two retinae respectively. The demonstration of this 
fact, not only most important in itself, but most essential to the due interpreta- 
tion of a vast number of other visual phenomena, was afforded by the Stereo- 
scope devised by Professor Wheatstone, the action of which was, to form upon 
the two retinae the two dissimilar pictures, not from the object itself, but from 
two perspective projections of such an object; the mental combination of these 
two pictures, and the consequent reproduction of the object to the mind's eye, 
being then found to be as complete as if the object itself had been placed before 
the vision. Thus two perspective projections of a cube, of a truncated pyra- 
mid, or of any other geometrical solid, drawn even in simple outline, when so 
cast upon the two retinae as to possess the forms and positions which they 
would have had if at once derived from the actual object, convey to the mind 
the most complete conception of that object ; and the illusion is still more com- 
plete, when the views are not mere outlines, but give the correct lights and 
shadows of the body from which they are taken. The most perfect illusion is 
derived from the employment of two photographic pictures, taken at the same 
time, by two cameras, placed so as to form about the same angle with the ob- 
ject as that which the axes of the two eyes would form by their convergence on 
it ; a portrait or statue being thus reproduced to the mind's eye with the com- 
pletest perception of its solidity. This application was made by Professor 
Wheatstone soon after the publication of the photographic processes of Fox 
Talbot and Daguerre, and was announced by him in 1841. A form of stereo- 
scope, partly contrived by Sir David Brewster, has recently come into general 
use, which has the advantage of portability over the original mirror-stereoscope; 
but it is limited to the exhibition of a much smaller variety of phenomena than 
that to which Professor Wheatstone's instrument can be adapted. 

We have given this resume of the fundamental idea of Professor Wheatstone's 
former memoir, and a notice of what he has subsequently done in the matter, 
because some very extraordinary attempts have been recently made to mystify 
the public as to the real inventor of the stereoscope, and the demonstrator of 
the true doctrine of Binocular Vision ; claims having been advanced by Sir 
David Brewster on both these points, for which there is not the shadow of a 
foundation. We believe ourselves to be fully acquainted with the whole his- 



1853.] 



Anatomy and Physiology. 



183 



tory, so far, at least, as it can be made out by published statements ; and we 
have not the slightest hesitation in making the assertion, that the entire merit 
of the idea of the original dependence of our visual perception of solidity upon 
the mental combination of the two dissimilar impressions made upon the two 
retinas — and further, that the whole merit of the realization of that idea, by 
means of the mirror-stereoscope, long before Sir David Brewster's attention 
had been given to the subject at all — belongs to Professor Wheatstone. 

The Second Part of Professor Wheatstone's experimental researches, com- 
municated to the Royal Society as the Bakerian Lecture for the present year, 
commences with an account of some remarkable illusions which occur when 
the usual relations which subsist between the magnitude of the pictures on the 
retinae and the degree of inclination of the optic axes are disturbed. Under 
the ordinary circumstances of vision, when an object changes its distance from 
the observer, the magnitude of the pictures on the retinas increases at the same 
time that the inclination of the optic axes becomes greater, and vice versa, and 
the perceived magnitude of the object remains the same. The author wished 
to ascertain what would take place by causing the optic axes to assume every 
degree of convergence, while the magnitude of the pictures on the retinae re- 
mained the same; and, on the other hand, the phenomena which would be 
exhibited by maintaining the inclination of the optic a?xes constant, while the 
magnitude of the pictures on the retinae continually changed. To effect these 
purposes, he constructed a modification of his reflecting stereoscope. In this 
instrument two similar pictures are placed, on movable arms, each opposite 
its respective mirror ; these arms move round a common centre in such man- 
ner, that, however they are placed, the reflected image of each picture in the 
mirrors remains constantly at the same distance from the eye by which it is 
viewed ; the pictures are also capable of sliding along these arms, so that they 
may be simultaneously brought nearer to, or removed further from, the mir- 
rors. When the pictures remain at the same distance, and the arms are moved 
round their centre, the reflected images, while their distances from the eyes 
remain unchanged, are displaced, so that a different inclination of the optic 
axes is required to cause them to coincide. When the arms remain in the 
same positions, and the pictures are brought simultaneously nearer the mir- 
rors, the reflected images are not displaced, and they always coincide with the 
same convergence of the optic axes; but the magnitude of the pictures on the 
retinae becomes greater as the pictures approach. The experimental results 
afforded by this apparatus, so far as regards the perception of magnitude, are 
the following : the pictures being placed at such distances, and the arms moved 
to such positions, that the binocular image appears of its natural magnitude 
and its proper distance, on the arms being moved so as to occasion the optic 
axes to converge less, the image appears larger; and on their being moved so 
as to cause the optic axes to converge more, the image appears less ; thus, 
while the magnitude of the pictures on the retinae remains constantly the 
same, the perceived magnitude of the object varies, through a very consider- 
able range, with every degree of the convergence of the optic axes. The pic- 
tures and arms being again placed, so that the magnitude and distance of the 
object appear the same as usual, and the arms being fixed, so that the con- 
vergence of the optic axes does not change; while the pictures are brought 
nearer the mirrors, the perceived magnitude of the object increases, and it de- 
creases when they are removed farther off ; thus, while the inclination of the 
optic axes remains constant, the perceived magnitude of the object varies with 
every change in the magnitude of the pictures on the retinae. After this, the 
author takes into consideration the disturbances produced in our perception of 
distance under the same circumstances, and concludes that the facts thus ex- 
perimentally ascertained regarding the perceptions of magnitude and distance, 
render necessary some modification in the prevalent theory regarding them. 

The author next reverts to the relations of these facts to the effect produced 
by the stereoscope. The two projections of an object, seen by the two eyes, 
are different, according to the distance at which it is viewed; they become less 
dissimilar as that distance is greater; and, consequently, as the convergence 
of the optic axis becomes less. To a particular distance belongs a specific dis- 



\ 



184 Progress of the Medical Sciences. [Jan. 

similarity between the two pictures, and it is a point of interest to determine 
what would take place on viewing a pair of stereoscopic pictures with a dif- 
ferent inclination of the optic axes than that for which they were intended. 
The result of this inquiry is, that if a pair of very dissimilar pictures is seen 
when the optic axes are nearly parallel, the distances between the near and 
remote points of the object appear exaggerated ; and if, on the other hand, a 
pair of pictures slightly dissimilar is seen when the optic axes converge very 
much, the appearance is that of a bas-relief. As no disagreeable or obviously 
incongruous effect is produced when two pictures, intended for a nearer con- 
vergence of the optic axes, are seen when the eyes are parallel or nearly so, we 
are able to avail ourselves of the means of augmenting the perceived magnitude 
of the binocular image mentioned at the commencement of this abstract. For 
this purpose the pictures, placed near the eyes, are caused to coincide when the 
optic axes are nearly parallel; and the diverging rays proceeding from the 
near pictures are rendered parallel by lenses of short focal distance placed be- 
fore the mirrors or prisms of the stereoscope. 

Some additional observations are next brought forward respecting those ste- 
reoscopic phenomena which the author, in his first memoir, called " conver- 
sions of relief." They may be produced in three different ways: 1st, by 
transposing the picture's from one eye to the other; 2dly, by reflecting each 
picture separately, without transposition; and, 3dly, by inverting the pictures 
to each eye separately. The converse figure differs from the normal figure in 
this circumstance, that those points which appear most distant in the latter are 
the nearest in the former, and vice versa. 

An account is then given of the construction and effects of an instrument for 
producing the conversion of the relief of any solid object to which it is directed. 
As this instrument conveys to the mind false perceptions of all external objects, 
the author calls it a Pseudoscope. It consists of two reflecting prisms, placed 
in a frame, with adjustments, so that, when applied to the eyes, each eye may 
separately see the reflected image of the projection which usually falls on that 
eye. This is not the case when the reflection of an object is seen in a mirror; 
for then, not only are the projections separately reflected, but they are also 
transposed from one eye to the other, and therefore the conversion of relief 
does not take place. The pseudoscope being directed to an object, and adjusted 
so that the object shall appear of its proper size, and at its usual distance, the 
distances of all other objects are inverted; all nearer objects appear more dis- 
tant, and all more distant objects nearer. The conversion of relief of an object 
consists in the transposition of the distances of the points which compose it. 
With the pseudoscope we have a glance, as it were, into another visible world, 
in which external objects and our internal perceptions have no longer their 
habitual relations with each other. Among the remarkable illusions it occa- 
sions, the following are mentioned: The inside of a teacup appears a solid 
convex body. The effect is more striking if there are painted figures within 
the cup. A china vase, ornamented with coloured flowers in relief, appears to 
be a vertical section of the interior of the vase, with painted hollow impressions 
of the flowers. A small terrestrial globe appears a concave hemisphere. When 
the globe is turned on its axis, the appearance and disappearance of different 
portions of the map on its concave surface has a very singular effect. But the 
most singular effect, to our eyes at least, is produced by looking at the interior 
of the base of the skull, which is brought out in relief, like the actual base of 
the brain which lies in it. A great number of other curious phenomena are 
brought into notice by this instrument ; and the whole subject is one of such 
extreme interest, both to the physiologist and the psychologist, that we rejoice 
to find that Professor Wheatstone is likely to pursue it with all the zeal and 
ability for which he has long been so conspicuous. — Brit, and For. Med. 
Chirurg. Rev. Oct. 1852, from the Proceedings of the Royal Society, Jan. 8, 
1852. ' ' 

3. Respiration of Muscles. — G. Liebig has been engaged in a series of expe- 
riments in relation to the above subject {Mull. Arch. 1850, p. 393. Froriep's 
Journ. 357, 1851), and has obtained the following results: 1. Muscles re- 



1853.] 



Anatomy and Physiology. 



185 



tain in oxygen their contractility much longer (often ten to fifteen hours) 
than in atmospheric air ; but, 2. Not so long in hydrogen or nitrogen as in the 
air. 3. In carbonic acid they lost their contractility in three to five hours, and 
became after five to eight hours white, broke easily in the fingers, the fibres 
having become dry, while the transparency of the muscle was entirely lost. 
4. During the continuance of contractility carbonic acid was produced. 5. 
The leg of a frog produced, within seventeen hours when in oxygen, 2.44 cen- 
tim. = 0.0048 gr. carbonic acid ; but in atmospheric air 2.06 = 0.0040 gr. carbo- 
nic acid. 6. A muscle, while its contractile powers are retained, absorbs oxygen 
from the atmosphere, and gives off carbonic acid. 7. Should water be forced 
into the arch of the aorta until the body is entirely free from blood, these mus- 
cles, deprived of blood, lost their contractility at the same time in oxygen as in 
atmospheric air ; however, not sooner than muscles in atmospheric air contain- 
ing blood. 8. Muscles deprived of blood pass into decomposition sooner than 
those which retain it, particularly when they are suspended in oxygen. 9. Car- 
bonic acid is given off and oxygen absorbed by muscles deprived of their blood, 
and they retain life longer in oxygen or atmospheric air than in nitrogen. 

C. W. 

4. Hermaphrodite Formation. — Samuel Stuart, Esq., gives the following 
description [Dublin Medical Press, Nov. 17, 1852) of a remarkable hermaphro- 
dite formation in a new-born infant : — 

" It is furnished with a double scrotum, which occupy, respectively, the situa- 
tion of the labia majora in the female ; each scrotum contains one testis. On 
the inner side of the right scrotum, in close connection with it, and pointing 
towards the left side, is a small-sized penis, about a quarter of an inch in 
length, or, more properly speaking, a glans only, with a prepuce, which is 
mostly retracted; by this rudimentary penis the urine passes freely. In the 
space between the scrota are tAvo openings of a circular form, capable of admit- 
ting a probe or small quill, and separated by a thin membranous septum. 
These openings occupy the situation of the urethra and vagina in the female, 
and seem to represent those organs; indeed, the upper one is a real urethra, 
the urine passing regularly through it, also in a full stream, though not at the 
same time that it passes by the penis ; thus showing, I believe, that there are 
two bladders. Whether the lower opening, which seems to represent the 
vagina, may lead to a uterus, I cannot say, though the presumption is that it 
does. At the point of junction of the scrota inferiorly, at the anterior margin 
of the perineum, a fleshy vascular tumour projects, about an inch and a half 
long, of an irregular pyriform shape. It has, about a week since, begun to dis- 
charge a dark, glairy fluid, which has reduced it in size, and it seems likely 
soon to disappear altogether. The child is healthy and thriving, and likely to 
live, as any child of its age/ 7 

5. Muscularity of the Valve which closes the Foramen Ovale. — Dr. Peacock 
exhibited to the Pathological Society of London (19th Oct.) a series of prepara- 
tions intended to illustrate the valve which closes the foramen ovale — a pecu- 
liarity of structure which, he thought, powerfully contributed to the permanent 
adhesion of this membrane, and the consequent completion of the auricular 
septum. The muscular character of this valve was first pointed out by Senac; 
it was, however, expressly denied by Haller, who remarked that the tissue com- 
posing it was purely fibro-cellular, and that the presence of muscular fibres 
was accidental and unusual. The examinations he (Dr. Peacock) had made, 
enabled him to refute the assertion of Haller and establish the truth of Senac's 
doctrine. Heretofore, the explanation afforded of the closure of the foramen 
ovale was purely mechanical. After birth, it is said, the pressure of the blood 
in each auricle becomes equal, and, no excess of force existing on either side 
of the foramen ovale, the valve is kept in contact with the edges of that aper- 
ture, to which, in process of time, it becomes solidly united. This explanation 
had always struck him as unsatisfactory, and, believing that muscular action was 
called into force for the purpose of bringing the valve in contact with the mar- 
gins of the foramen ovale, he made a scries of dissections, which established 



186 



Progress of the Medical Sciences. 



[Jan. 



the truth of this opinion. Without muscular fibre, indeed, it would be difficult 
to explain the closure of the orifice ; for, after birth, the pressure of the blood 
in both auricles is not so certainly equalized, for there are instances in which 
the walls of the left auricle are scarcely stronger than those of the right, while 
the cavity of the right auricle remains larger, and hence superiority of" force on 
the right side of the valve exists, which, but for some counteracting agent, 
would drive the flapping membrane into the cavity of the left auricle, and pre- 
vent the completion of the septum. Indeed, there were instances in which, the 
muscular fibres of the valve being few and weak, the condition adverted to 
prevented the establishment of a perfect auricular septum, and the valve, instead 
of cohering properly to the margins of the foramen ovale, yielded under the pres- 
sure, and became converted into a saccular dilatation, which, as one of the spe- 
cimens on the table demonstrated, projects in the form of a bag into the left 
auricle. Occasionally, the cellular tissue between the muscular fibres of the 
valve, yielded, being ruptured either by the pressure of the blood or by the 
action of the muscular structure, and this occurrence resulted in the formation 
of a cribriform septum, of which there was also a specimen on the table. This 
condition of the valve was generally coexistent with contraction of the orifice 
of the pulmonary artery. The muscularity of the valve was not apparent till 
after birth, and, as Senac has noticed, the muscular fibres were most marked 
on its left surface. In the hearts of fishes, and of reptiles, such as the turtle, 
the valve manifested a muscular structure more plainly than in the human 
subject. 

In answer to an inquiry at what age he supposed perfect closure of the fora- 
men ovale took place ? Dr. Peacock stated that he was unable to answer that 
question ; but he felt sure that if the foramen was not closed early in life it 
was never closed at all, and he believed the cases were very numerous in which 
it remained patulous. Preparations, demonstrating the different conditions of 
the adherent valve and its muscularity, were handed round. — Med. Times and 
Gaz. Oct. 30, 1852. 

6. On the Structure and Development of Bone. By John Tomes, F. R. S., and 
Campbell de Morgan, Esq. (Read to the Royal Society.) 

1. Haversian and other Canals of Bone. — Besides the Haversian canals, the 
authors have pointed out that there are found in bone-sections spaces of an en- 
tirely different character, irregular in shape, and with an irregular festooned 
margin. Their margins correspond in outline with those of one or more 
Haversian systems, and precede in many instances the formation of those 
systems. These spaces, produced by absorption, are called by the authors 
Haversian spaces. Unlike the Haversian canals, which are surrounded by 
their own laminae, these spaces are bounded by parts of several systems Avhich 
have been encroached on by the process of absorption. In examining various 
sections, or different parts of the same section, many of these spaces will be found 
partially or entirely occupied by Haversian systems. They are found in the 
bone of subjects of all ages. 

2. Laminae of Bone. — Lamination is shown to be a constant character of 
mammalian bone; each lamina, when highly developed, is found to consist of 
a dark granular, and of a transparent part. The external margin of the outer- 
most lamina of each Haversian system is irregularly indented, and corresponds 
with the boundary of a pre-existing Haversian space ; while its internal margin 
and all the succeeding laminae are regular in outline. The laminae are found, 
as a general rule, to surround their canal, which is usually placed in the centre 
of them ; but sometimes the canals are eccentric ; in which case, either the 
laminae on one side, though still surrounding the canal, are broader, or there 
are mure developed on one side than on the other. The lamina next to the 
perfected Haversian canal, however, is always complete, and is often composed 
of a transparent structureless tissue, like that which encircles the Haversian 
canals of the stag's antler at the time of shedding. The presence of interstitial 
laminae is readily accounted for ; they are, in fact, the remains of pre-existing 
Haversian systems, or circumferential laminae, parts of which have been re- 
moved by absorption. The circumferential laminae are not so constantly pre- 



1853.] 



Anatomy and Physiology. 



187 



sent as is generally described, and seldom entirely surround the shaft of a long 
bone. When present, they seem to indicate that the bone is nearly stationary 
in its growth. They are frequently intersected by numerous Haversian spaces 
and systems, so as at length to assume the characters of interstitial laminae. 

3. Lacuna. — In young bone, the lacunae are more abundant, larger, and have 
more numerous canaliculi ; in older bone, they may exist without canaliculi, or 
the canaliculi and great part of the lacunae themselves may be filled up with 
solid matter, so as to leave only a small space in the centre of the latter. The 
lacunae and canaliculi are shown to have distinct walls. In the circumferential 
laminae are frequently found elongated tubes which the authors regard as modi- 
fications of lacunae ; they run obliquely across the laminae, generally in bundles. 
They frequently form communications with the canaliculi. In transverse sec- 
tion they are seen to have proper walls. 

4. Haversian Systems. — The authors have pointed out that the anastomosis 
of the canaliculi of adjoining systems is rare in newly-developed systems, but 
is very common in those of greater age. It not unfrequently happens, that two 
or more Haversian systems are contained within a common series of surround- 
ing laminae. Sometimes the Haversian systems are rendered solid by the nar- 
rowing of the Haversian canal and ultimate development of a mere lacuna in 
the centre of the system. The more recently developed Haversian systems 
which occupy the Haversian spaces before noticed, are seen to be darker in 
colour than the older ones, from the greater abundance of canaliculi, and the 
more general granularity of the tissue. 

5. Ossified Articular Cartilage. — This structure the authors have found in all 
the joints which they have examined in the lower jaw, amongst others, where 
Kolliker failed to detect it. Towards the bone the tissue becomes in general 
granular, and of a brownish colour, and usually there is a distinct line of de- 
marcation between the bone and the ossified cartilage ; but sometimes they 
graduate insensibly the one into the other. Towards the articular surface the 
margin is even and regular ; but towards the bone it is deeply indented, from 
the bone advancing into it by rounded projections. Hence the articular car- 
tilage varies in thickness. The authors believe that this tissue, so far from 
being a result of imperfect development, is in reality an evidence of design, 
and intended to give a uniform and unyielding surface for the cartilage to rest 
upon. 

6. Ossified Cells. — It is frequently observed, that the bones of aged people 
become light and spongy, and, after maceration, contain a white powder in the 
cancellated structure. This powder the authors have found to be composed 
mainly of ossified nucleated cells, either detached or held together in masses. 
They are spherical, and contain a dark granular nucleus, which is surrounded 
by a thick transparent wall. If portions of the cancelli be examined, they will 
be found to have similar cells adherent to their surfaces, or to those of the 
Haversian canals, with here and there canaliculi of adjoining lacunae shooting 
into them, while the nuclei have themselves assumed the form of lacunae. 
Similar cells may be found imbedded in parts of most sections of bone. In 
order to see this condition clearly, it is desirable that the sections and the loose 
cells should be mounted in Canada balsam. 

7. Bone Tissue. — The views generally entertained with regard to the ultimate 
structure of bone tissue are, the older one, that it consists of an aggregation of 
granules in a transparent matrix; and that which has been more recently put 
forward by Dr. Sharpey, that in many cases it is composed of ossified decus- 
sating fibres. The authors have satisfied themselves that the ultimate structure 
of bone tissue is composed of minute granules or granular bodies imbedded in 
a clear or sub-granular matrix ; and that the appearance of fibres is due in many 
cases to the mode of illumination. By transmitted light passing through them 
in the long axis of the microscope, the preparations show a granular or a 
structureless appearance, or alternations of a granular and structureless part. 
But under an oblique light passing from one side only an appearance of minute 
fiat fibres presents itself. This takes place even in the isolated cells of old 
bone, or in developing young bone. The appearance is most marked over the 
lacunae and canaliculi. But if a part which thus appears fibrous be viewed 



188 



Progress of the Medical Sciences. 



[Jan. 



under a light passing obliquely from all sides, as is effected by a Gillett's 
achromatic condenser, the fibres disappear, and we see only a granular appear- 
ance, with some tendency to arrangement in the granules. The fibrous ap- 
pearance is in fact due to the shadows cast from the less transparent parts 
when the light passes obliquely, just as, in the navicula, the dots are replaced 
by lines. In thin sections, torn from bone which has been macerated in acid, 
a reticulated appearance, similar to that figured by Dr. Sharpey, may be seen, 
only, however, when the object is slightly out of focus, or the light oblique and 
from one side. By careful adjustment of the object-glass, and of the illuminat- 
ing apparatus, this appearance may be shown to depend upon the presence of 
the canaliculi. 

Development and Growth of Bone. — The early condition of cartilage, and the 
changes which take place in it and in the cartilage cell before ossification, are 
particularly described ; and also the mode by which they multiply and arrange 
themselves by segmentation, so that a long column or cluster of cells represents 
an original cell, the walls of which have coalesced with the surrounding hya- 
line tissue. The cells, at the same time, enlarge individually as they approach 
the point where ossification is going on, encroaching on the hyaline substance 
so as in many cases to leave only a fine line of intercolumnar tissue, or even to 
cause it to disappear altogether. The nucleus, at the same time, enlarges con- 
siderably, while the cell- wall becomes thickened internally, until, in the end, it 
reaches the nucleus, which then becomes imbedded in firm tissue. Other 
changes now take place ; either several cells are thrown into one cavity by the 
absorption of their contiguous walls, leaving the nuclei free in the common 
cavity, or the nucleus continues to occupy its parent-cell, and sends off small 
processes, which extend outwards to the cell-wall. At this stage the nucleus 
may be sometimes detached with the processes entire, but generally it is adhe- 
rent, and may be seen to have become a lacuna with a central cavity and canali- 
culi ; in addition to which, a nucleus may be seen to occupy its interior ; it has, 
in fact, become a nucleated-cell, designated by the authors " granular cell." 
The entire cell may now be detached from the intercolumnar tissue in which it 
lies. The granular condition of the intercolumnar tissue, and of the cell itself, 
often renders the observation of this stage very difficult; but in ricketty bone it 
is very readily shown, as in this disease there is a tendency for the cells to 
assume their permanent form before the deposit of bone-earth in any consider- 
able quantity. To cells thus composed of an outer thickened cell-wall, and an 
inner granular-cell (the cartilage nucleus of authors), which contains within it 
a nucleus (the nucleolus of writers), which stands in the relation of a nucleus 
to the future lacuna, the authors have given the name of " lacunal-cells," while 
the term " granular-cell" has been applied to that which is usually designated 
the nucleus. In transverse sections of bone immediately below the line of 
ossification, the lacuna! cells may be seen presenting different characters under 
different circumstances. Where two cells come into contact, the processes or 
canaliculi may be seen extending from one to the other; but where the cell is 
surrounded by intercolumnar tissue, the processes are short, and do not extend 
beyond the walls of their own cell ; or, if cells join at one point, while the re- 
mainder is invested with intercolumnar tissue, the canaliculi will anastomose 
at the point of junction ; while elsewhere they are few, short, and do not extend 
beyond the cell. In the further process of development, the cells and inter- 
columnar tissue become fused together, so as no longer to be recognized as 
distinct parts ; and the granular cell appears as a perfect lacuna with a large 
cavity and numerous large canaliculi. To bone in this condition the term 
" primary bone" has been applied. It speedily, however, undergoes a change, 
preparatory to the formation of the more permanent secondary bone. Here 
and there in the line of ossification portions are removed by absorption, the 
spaces left being filled with small somewhat granular cells, lying in a trans- 
parent blastema, through the agency of which the absorption has been, in all 
probability, effected. It would appear as though the cells grew at the expense 
of the surrounding tissue. These spaces correspond entirely to the Haversian 
spaces before described ; and in them the secondary bone is in the first instance 
formed. The process of formation of secondary bone appears to be everywhere 



1853.] 



Organic Chemistry. 



189 



essentially the same, whether in the absorbed spaces, or on the surfaces, or in 
the membranes of the foetal cranium, except that in the two latter cases there 
is a pre-existing fibrous tissue, which, before ossification begins, undergoes a 
change similar to that which occurs in the bone itself, and is converted into k 
cellular mass ; so that at the border where ossification is advancing there is 
only an arrangement of cells ; while a little beyond that point the cells have 
fibrous tissue abundantly mixed up with them ; and there is, in fact, a resem- 
blance to fibrous tissue in an early state of formation. The formation of per- 
fect bone is effected by means of cells, perhaps identical with those which are 
found replacing the previous tissue, but at all events undistinguishable from 
them by any microscopical characters. To these cells, which take part in the 
formation of bone, the authors have given the name of " osteal cells."* In the 
case of laminated bone they arrange themselves side by side, and, together with, 
the transparent blastema in which they lie, become impregnated with ossific 
matter, and permanently fused with the bone tissue with which they lie in con- 
tact. By the linear arrangement of these osteal-cells, lamination is produced. 
In the case of non-laminated bone the cells are simply ossified without arrange- 
ment. Lying among the osteal-cells will be seen some which have accumulated 
around them a quantity of tissue which forms a thick investment to them ; they 
then become granular, and take on in every respect the characters of a lacunal- 
cell. These are deposited at intervals along the line of ossification, and be- 
come blended with the general mass, the granular cell remaining as a lacuna, 
and sending out processes among the osteal-cells in all directions. In old bone, 
the cell character is in great part lost by a general blending of the constituents, 
but may in many specimens be still here and there recognized. Many instances 
are given in support of the conclusion, that absorption of bone and of dental 
tissue is effected directly through the influence of cells. We cannot, however, 
enter more fully into the subject, especially as many points cannot be rendered 
generally intelligible without reference to the specimens, or to the numerous 
drawings which accompany the paper. — Med. Times and Gaz. Oct. 2, 1852. 



ORGANIC CHEMISTRY. 

7. On the Condition of Albumen in the Economy. — M. Mialhe states, in the 
following propositions, the results of a series of chemical and physical investi- 
gations which he has been pursuing: — 

1. The normal albumen of the serum of the blood and of white of egg does not 
traverse animal membrane. When, in endosmotic experiments, there appears 
a certain amount of albuminous matter in the external fluid, this is not normal, 
but i modified albumen, proceeding from the maceration of the membranes, which 
have allowed the transudation of the albuminous matters with which they have 
become impregnated. When the animal membranes are placed in a preserva- 
tive fluid, as syrup, or the membranes of the egg, which long resist maceration, 
and are perfectly endosmotic, are employed, the serum of the blood and white 
of egg never traverse them. Albumen is then insoluble. — 2. This condition of 
insolubility should imply an organization similar to that of other substances 
which do not obey the laws of endosmosis, as fibrine, caseine, and cruor in ani- 
mals, gluten and starch in plants — substances known to have a globular organi- 
zation, and held in suspension by the liquids which act as their vehicles. The 
globular condition of albumen cannot be directly seen by the microscope, or even 

* The views here brought forward of the removal and replacement of tissue 
through the agency of cells are, so far as the authors know, entirely new ; and may 
have an important bearing on many points of physiology and pathology. Indeed, this 
is, perhaps, the first time that the fact (which has been generally assumed) of the 
entire absorption of tissue in the processes of nutrition, and its replacement by new 
tissue, has been demonstrated. 

No. XLIX.— Jan. 1853. 13 



190 



Progress of the Medical Sciences. 



[Jan. 



■with the aid of barytes-water ; and in spite of the analogies which lead to its ad- 
mission, it cannot be considered as demonstrated. But it is certain that it must 
have a special organization, which keeps it in a state of suspension instead of 
solution, and renders it precisely similar in chemical and physical properties to 
globular substances. — 3. Like these globular substances, it must undergo modi- 
fications, in order to enter the economy, which render it soluble, and capable 
of assimilation ; and albumen, modified by the ferment pepsin, becomes quite 
soluble, and capable of traversing membranes. — 4. In consequence of these 
transformations, albumen exists in the economy in three very different condi- 
tions as regards their properties — viz., normal albumen, modified or caseiform 
albumen, and albuminose. — 5. Morbid influences, by modifying the conditions 
of the physiological state of the membranes and the liquids, give rise to phe- 
nomena different from those which occur in the normal state. As a conse- 
quence of inflammations, excess of watery principles, defective viscosity, or the 
introduction into the economy of virus, miasms, poisons, or putrid ferments, 
the membranes cease to be endosmotic, and only present the phenomena of 
imbibition or filtration, analogous to those which take place after death. The 
vitiated and disorganized liquids (the blood'and its elements) transude through 
the vessels, and appear in the splanchnic cavities, the cellular tissue, or the 
products of secretion. — 6. Amidst this passage of albuminous matters into the 
dejections, we again meet with the three conditions of albumen, each connected 
with different pathological states — viz., normal albumen in extreme alterations 
of tissue, modified albumen in a vitiated state of the fluids, and albuminose 
in defective assimilation, or under the choleric influence. — Brit, and For. Med.- 
Chirurg. Rev. Oct. 1852, from L' Union Medicate, No. 90. 

8. On the Habitual Presence of Sugar in the Urine of the Aged. — By M. 
Dechambre. — During the great impulse which investigations into the charac- 
ters of the excretions have received in the present time, we ought to be certain 
that some principles discovered are really due to a pathological condition, and 
do not, under some circumstances, exist normally. M. Bernard has shown that 
sugar may be physiologically produced by the liver ; and the question is, what 
becomes of it. M. Reynoso has suggested that it is destroyed by pulmonary 
combustion, and that when the respiratory function becomes impeded, it will 
be found excreted in the urine. M. Dechambre taking up the question at this 
point, argues, that if insufficient hasmatosis gives rise to glucosuria, we ought to 
meet with this in the aged. He refers to the well-known researches into the 
condition of the respiratory organs of the aged, carried on by himself and M. 
Hourmann at the Salpetriere, and described in the Arch. Gen. for 1835. These 
exhibited lateral depression of the thorax, projection of the sternum forwards, 
rigidity of the costo-vertebral articulations, ossification of the cartilages, and a 
rarefied condition of the pulmonary parenchyma, in which the cell-walls were 
found thinned or ruptured, and the capillary vessels obliterated. The defective 
haematosis which results from these physical changes should, then, favour the 
production of glucosuria ; and experiments performed upon the urine of a con- 
siderable number of the aged women of the Salpetriere have so constantly 
exhibited it, that M. Dechambre considers himself justified in asserting that 
sugar exists habitually in the urine of the aged, although its presence there may 
be possibly explained upon some other hypothesis. — Brit, and For. Med.- 
Chirurg. Rev. Oct. 1852, from Rev. Med.-Chirurg. torn. xi. p. 289. 



MATERIA MEDICA AND PHARMACY. 

9. Cod-Liver Oil. — The admitted therapeutic advantages of this drug have 
excited a laudable desire on the part of many chemists, who make their scien- 
tific pursuits subservient to the practice of physic, to ascertain in what portion 
of its constituents its acknowledged remedial powers reside. The notion that 
the active agent was the almost infinitesimally small amount of iodine it con- 



1853.] 



Materia Medica and Pharmacy. 



191 



tains, or the so-called gaduin of Dr. De Jongh, both of which are evidently 
merely impurities in the oil, has neither deserved nor obtained any general 
belief in the assertions that the powers of cod-liver oil could be rationally attri- 
buted to either iodine or gaduin. Dr. H. Winckler has, however, propounded 
a theory respecting cod-liver oil, far more reasonable than any which have yet 
appeared, and this he has supported by various experiments, which lend great 
weight to his hypothesis. This is, that cod-liver oil is a peculiar organic com- 
pound, differing in its constitution from all the oils which had hitherto been 
employed in pharmacy. It appears that when cod-liver oil is saponified with 
potash, it is converted into oleic and margaric acids, and oxide of propyl ; that 
when oxide of lead is substituted for potash, propylic acid is formed, and that 
in no case is oxide of glycyl (glycerine), the usual product of saponification, 
produced. Thus, whilst other oils consist, for the most part, of oleic, margaric, 
or stearic acids combined with glycerine, the hydrated oxide of glycyl ; cod- 
liver oil is composed of the two former acids united to an oxide of the base 
propyl, C 6 H 7 , replacing glycyl, C 6 H 2 , the usual- basis of oils. These experi- 
ments and views of Dr. Winckler merit attention, for they shed much light 
upon the remedial nature of this oil, leading us to believe that it is a substance 
sui generis, differing not merely in its therapeutic action, but also in its chemi- 
cal constitution from all other of the fatty oils used in medicine. — Lond. Journ. 
Med. Sept. 1852. 

10. Sulphate of Nickel as a Therapeutic Agent. — Prof. Simpson, of Edinburgh, 
impressed with the belief that some of the new metals, like some of the old 
ones, will turn out to have decided, and, it may be, very important therapeutic 
properties, has made various therapeutic experiments with several of the for- 
mer, among others with cadmium, iridium, tellurium, &c, but particularly 
nickel. This last, he has most frequently used in the form of a salt, and he 
gives the following statement of his results : — 

" Sulphate of nickel has appeared to me to act as a gentle metallic tonic. I 
have generally used it in doses of half a grain or a grain, repeated thrice daily ; 
and have given it in the form either of simple solution or of pill. In large 
doses, it is liable, like sulphate of zinc or copper, to produce sickness and nau- 
sea, particularly if taken upon an empty stomach. I have generally requested 
it to be taken half an hour or an hour after meals. It has appeared to me, as 
the result of pretty numerous experiments and observations, that the thera- 
peutic actions of the salts of nickel and manganese correspond in a consider- 
able degree with the therapeutic actions of the salts of iron upon the economy ; 
and that these three metals might, under many conditions, be almost used as 
therapeutic substitutes for each other. But they also specifically differ from 
each other in some respects. For example, in one most interesting case, the 
sulphate of nickel arrested a severe form of periodic headache, which had pre- 
viously defied iron in many different forms, and all other kinds of treatment 
that had been employed. The patient came from Italy last autumn, in order 
to place herself under my professional care ; and for some months I was as 
unsuccessful as my predecessors had been in affording her any relief. But let 
me give the history of the affection, and the ultimate result, in the lady's own 
words. She drew up the following note of her case several weeks ago : — 

"'My headaches (she writes) came on soon after my second confinement in 
August, 1847, and continued to return every tenth day without intermission, 
up to the 1st of February, 1852. During the first four years I was in Italy, and 
was attended by medical men of all countries — English, French, German, and 
Italian. I also tried hydropathy and homoeopathy, the latter for six months, 
but all without the slightest effect. The pain came on in a small spot on the 
right temple, and lasted from twenty-four to thirty-six hours. After the first 
eight hours severe sickness followed, which continued up to the sixteenth 
hour. During the attacks I had violent cold shivering fits, succeeded by a 
burning fever. At times I was quite delirious from the violence of the pain. 
I have taken large doses of steel, iron, and quinine, besides many other sorts 
of medicines. The quinine I took at first only two days before the attack was 
expected. I then took six grains every day for a year and a half, but it never 



192 



Progress of the Medical Sciences. 



[Jan. 



put off the headache a moment beyond its day and hour, nor would anything 
that I could do bring it on before the time. When I first came to Scotland, to 
be under the advice of Dr. Simpson, in August, 1851, he gave me thirty grains 
of quinine a day for three days before the headache was to come on ; but it 
returned to its hour, and as severe as ever. This was tried also with the next 
fit, with no better success. Dr. Simpson then tried successively furfurine, be- 
beerine, and arsenic, but the headaches still continued up to the 1st of Feb- 
ruary, 1852, on which day I had a most severe attack. On the 4th of February, 
he gave me the solution of sulphate of nickel to take ; since which time, to my 
astonishment, my usual headaches have altogether disappeared/ 

" To the preceding account I have merely to add, that, if we may judge from 
the result up to the present time, the cure of this patient from the use of nickel 
appears entire and complete. And perhaps it is but proper to remark, that 
this result seems fairly attributable to the action of the nickel alone, inasmuch 
as there was no relief under the use of any of the means or medicines pre- 
viously employed for years ; while convalescence distinctly began from the date 
of the employment of the metal in question. 

"Further, it is perhaps not unimportant to observe, that while the disease 
had lasted four years without abatement, its subsidence in February could not 
be the result of change of climate, as the lady had already resided about five 
months in Edinburgh or its neighbourhood, without any noticeable amelioration 
in the recurrence and intensity of the headaches; and at last they disappeared 
under the nickel, at a period of the year — viz., the commencement of spring — 
at which, in our climate, headaches and other periodic diseases are known to 
be specially liable to become increased and aggravated. 

"In no kind of case is the beneficial action of iron more remarkable than in 
the treatment of chlorosis and amenorrhcea. I have seen nickel in a similar 
way apparently serviceable under the same circumstances. In the latter end 
of last year, I gave it in a case of amenorrhcea of ten years' duration. The 
amenorrhcea supervened at the age of twenty-two. At the same time a gal- 
vanic intra-uterine bougie was introduced, and left for some time in the cavity 
of the uterus. In the course of three or four weeks menstruation took place, 
and has recurred regularly from that period. In such a case, however, it is 
difficult to say how far the result was attributable to the local means used, and 
what share the nickel had in the restoration of the patient's health/' — Monthly 
Journ. Med. Sci. August, 1852. 

11. Therapeutic Action of Furfurine. — Professor Simpson has experimented 
with furfurine — an alkaloid which produces, in experiments with poisonous 
doses upon the lower animals, many of the symptoms of quinine; and the 
salts of which he has found to act as a tonic, if not as an antiperiodic, when 
exhibited to the human subject. — Monthly Journ. Med. Sci. August, 1852. 

12. Experiments with Digitaline, performed by M. Andral in the Hopital de la 
ChariU. — Dr. Lemaistre in an interesting memoir {U Union Medicate, May, 
1852) describes first the nature of the cases experimented on ; second, the mode 
of administration of digitaline; thirdly, the various effects produced; and, 
lastly, draws some conclusions as to the therapeutic effects of the drug. 

Nature of the Cases. — Nineteen patients were experimented on, viz. ; several 
cases of chronic heart-disease ; one of albuminuria ; one of anaemia with inter- 
mittent fever ; two of phthisis ; one of acephalocyst of the pleura, with all the 
signs of extensive pleural effusion ; two of acute pleurisy; two of acute rheuma- 
tism : one joint only being affected in one case, and several in the other. 

Mode of Administration. — The digitaline was given in granules, according to 
the formula of M. Quevenne: each granule containing a milligramme (.015 of a 
grain). One granule, sometimes two, was first given in twenty-four hours; 
and the number was gradually increased to four. Six or seven granules in the 
day produced toxic symptoms : in one case, that of a youth of fifteen, obstinate 
vomiting was produced after two granules had been given. Commonly, it was 
on the third or fourth day, and after giving two or three granules per diem, 



1853.] 



Materia Medica and Pharmacy. 



193 



that vomiting, diarrhoea, and cephalalgia were produced. In other cases, five, 
six, or seven granules have been taken in the twenty-four hours without incon- 
venience : and, in two cases, ten and twelve were taken. The duration of 
treatment has varied from a few days to one or two weeks. The greatest num- 
ber of granules administered during a course, has been, in five cases, respect- 
ively 23, 33, 44, 50, and 88 — the latter including two courses. 

Action of Digitaline. Circidation. — The following table shows the action of 
digitaline in lowering the frequency of the pulse : — 





Minimum of Pulse 
before treatment. 


Minimum of Pulse 
during treatment. 


Difference 


Disease of the heart 


. • • . 108 


68 


40 


' . • ' U 1 v •'" , 


. 92 


72 


20 


v tt \ . ' i «• - \ ■ / ;• 


. 80 ' ' 


68 


12 


<( 


-. ■ •■ 76 ' • ' 


51 


25 


'ttljfc) GtW'h ''■,'«"' .'. '•''•/' ' '. * 


. 104 


100 


4 


tt • ■' , w 


'. . 64 


60 


4 




. 44 


, 44 





<< 


.76 


58 


18 


Phthisis .... 


. ' . 84 • ■ 


76 


8 




. • ."'68 • 


64 


4 


Pleurisy .... 


. 108 


100 


8 


. 108 


116 




Hydatid of pleura 


. 100 


96 


4 


Rheumatism in one joint 


. . 96 


80 


16 


" in several joints 


. 96 


80 


16 


Anaemia .... 


. . 80 


76 


4 



Some writers have described a much greater effect as being produced on the 
pulse than is shown in these tables ; this has probably arisen from their hav- 
ing adopted, as a normal standard, the pulse of the patients at their first visit, 
and when they were excited by the presence of the medical attendant. Dr. 
Lemaistre observes that this will sometimes make a difference of twenty pulsa- 
tions in a few minutes: and a great difference may even arise in a few moments. 
M. Andral did not give the digitaline until he had ascertained the state of the 
pulse by repeated examinations during several days. 

The author (from the small number of observations) does not venture to 
recommend digitaline for its effect on the pulse, except in heart diseases ; in 
which, by calming the circulation, it renders the pulse regular where it was 
before irregular. Very small doses will often produce this effect. 

Digestive Organs. — The tongue almost always remained moist, without fur. 
The appetite and thirst were not influenced, except when poisonous effects 
were produced : then the desire for food was lost. During the first days of 
administering the digitaline, no effect was produced on the stomach. After a 
certain time, slight pain occurred : and, on the next day, there was nausea, 
sometimes followed by vomiting, usually abundant and mucous, and continu- 
ing for some hours, or even an entire day. These effects did not generally fol- 
low immediately after the administration of the medicine. The almost uniform 
coincidence of cerebral disturbance with these symptoms leads to the belief, 
that the gastric disorder was in a great measure sympathetic. There was, 
however, probably some direct effect on the intestinal mucous membrane. At 
first, there were borborygmi ; the abdomen at the same time became somewhat 
distended, then slight spasmodic pains were felt; diarrhoea at last appeared, 
but was always scanty, and was preceded sometimes by colicky pains. All 
these symptoms soon disappeared, on ceasing the use of the medicine. Four 
or five granules per diem generally produced the disturbance of the digestive 
organs; in some cases, no such phenomena were observed. 

Respiration. — In diseases of the heart, as soon as the calmative effect on the 
circulation was produced, the respiration, which had been oppressed, short, 
and anxious, became easy, full, and normal. In a case of phthisis, the patient 
said that his pulsation had become easier. But what conclusion can be drawn 
from a single case? In one or two cases the respiration was disturbed; one 



194 



Progress of the Medical Sciences. 



[Jan. 



patient complained of a sense of weight "behind the sternum, of a kind of 
oppression which obliged him to sit up at night, the expectoration being at the 
same time impeded. These symptoms were evidently connected with cerebral 
disorder. MM. Andral and Lemaistre have not found much worthy of notice 
in the action of digitaline-on respiration. 

Kidneys. — In most of the cases, the patients passed urine more frequently; 
but it does not follow that the quantity of urine was always increased. In two 
cases of disease of the heart, and in the two cases of pleurisy, there was no 
increase in the quantity of urine. In the case of pleural hydatid, a little more 
urine was passed. In two cases of heart disease, in one case of phthisis, and 
in the case of albuminuria, the quantity was doubled, tripled, or even quad- 
rupled: the urine at the same time became pale, and the specific gravity fell 
from 1012 and 1016 to 1008, 1004, and 1003. The diuretic effect was first 
observed on the third or fourth day ; it continued two or three days, then 
rapidly decreased, and ceased entirely in some days, notwithstanding the con- 
tinued use of the medicine. The diuresis was most abundant where there was 
oedema of the cellular tissue, which disappeared in a few days; while, in pleu- 
ral effusion, the digitaline had little or no effect. The indications for the use 
of digitaline are then the same as for hydragogue purgatives ; these succeed in 
cases of dropsy connected with albuminuria or heart disease, but fail in dropsy 
from local causes, as hydrothorax, hydropericardium, encysted dropsies, etc. 

To obtain the diuretic action of digitaline, a full dose is generally required, 
and it must be given for three or four days. The authors believe that the digi- 
taline does not act directly on the kidneys, but that it augments their secretion 
by lowering the circulation. 

Nervous System. — In several patients, no effect was produced ; but, in a large 
number of cases, the patients slept from a quarter of an hour to three hours 
during the day, although they had slept as usual during the night. This sleep 
appeared only at the commencement of the treatment, and was not perceived 
in a few days. The sleep was calm, and in no way fatigued the patients ; it 
arose from the direct action of the digitaline on the brain. In other cases, 
there was merely some lassitude. But at a later period, when toxic pheno- 
mena, as disturbance of the stomach and intestines, appeared, then there some- 
times occurred a heavy sleep, from which the patients awoke suddenly, and 
which fatigued them much. This was much less frequent than the first- 
described form. 

The other most frequent disturbances of innervation were the following: 
The patient at first experienced general malaise; the head felt heavy; sleep, 
instead of being increased, was not only diminished, but even disturbed by 
frightful dreams, or even abolished, and replaced by constant restlessness. 
These symptoms were soon followed by cephalalgia lasting for several hours, 
with disturbance of vision : diplopia occurred in one case, Flashes of heat 
and vomiting were then observed. In a more advanced stage, the patients 
experienced vertigo ; in other cases, there was extreme debility, and even faint- 
ing. In one case, the intellect was weakened, the countenance was dull, and 
questions were answered slowly. All these symptoms occurred only after the 
digitaline had been taken four or five days, and when the daily dose had been 
increased to four, five, or six granules. In one case, ten granules per diem 
produced no effect; while in another, two granules gave rise to symptoms of 
poisoning ; but these were exceptional cases. 

The disorders of innervation, like those of digestion, ceased or disappeared 
when the medicine was discontinued. 

Conclusions. — Digitaline may be administered with benefit in cases of chronic 
heart disease, where the pulse is elevated and the circulation irregular : and in 
cases of dropsy arising from disease of the heart, or from an alteration in the 
blood. The effects over the circulation and renal secretion have been obtained 
by three granules a day; and four or five granules have produced toxic acci- 
dents: hence it is best not to give more than three granules, except in some 
rare cases. Instead of granules, an alcoholic solution may be employed, con- 
taining about three milligrammes in thirty drops. The action of digitaline 
seems nearly the same as that of digitalis, with the advantage of producing 



1853.] 



Materia Medica and Pharmacy. 



195 



less irritation of the digestive mucous membrane, and being more uniform in 
strength. — Lond. Journ. Med. Sept. 1852. 

r 13. On the Action and on the Method of preparing Cathartine. — Trenkler pre- 
pares cathartine from the unripe green berries of rhamnus cathartica. It resem- 
bles pure aloethine, both in a chemical and in a therapeutical point of view. 
One or two grains of cathartine in the form of pills usually produce one or two, 
or in a susceptible patient, three or four pulpy stools, without griping. Three 
grains form a large dose. If the first dose should fail to produce the desired 
effect, a second may be given in three or four hours. Dr. Graff (of Darmstadt), 
who has carefully studied its therapeutic action, employs it in torpor of the 
bowels, in hepatic and splenic congestions, hemorrhoids, dropsy, and gout. 

By simply treating the inspissated juice of the unripe berries with alcohol 
and ether, we may obtain an impure cathartine in considerable quantity (oz. 
viij, from 12 lbs.), which acts very powerfully, and much like aloes. — Prov. 
Med. and Surg. Journ. October 13, 1852. From Jahrb.f.pr. Pharm. January, 
1852. 

14. On the Action of Trisnitrate of Bismuth. — Dr. Lussana has been recently 
experimenting with this substance. In opposition to the views of Monneret, who 
published a memoir on it a few years ago, in which he maintains that it merely 
exerts a local and no general influence, and that it acts as a sedative on the in- 
testinal mucous membrane, Lussana asserts that it certainly has a general 
action, and that it is absorbed into the system. 

The following are the results of his experience of large doses in diarrhoea 
tuberculosa, in the diarrhoea accompanying chronic enteritis, in inveterate gas- 
tralgia, and in mesenteritis. It excites no irritation of the intestinal mucous 
membrane ; it cannot check tuberculous and mesenteric diarrhoea. The feces 
were of a brownish-black colour, from the formation of sulphuret of bismuth 
in the intestine. A portion of the dose, varying with the amount of acid in the 
stomach and intestines, was dissolved and absorbed ; but any of the dissolved 
portion, on meeting with an excess of alkaline chlorides in the intestine, was 
again precipitated. For this reason, it never appears in the urine, being pre- 
cipitated by the alkaline chlorides in the blood serum. Its passage into the 
blood gives rise to colliquative and scorbutic phenomena. 

To avoid this noxious general action, and at the same time to avail ourselves 
of the mechanical and local healing power of this medicine, we should pre- 
viously give some antacid, as, for instance, magnesia usta, which would chemi- 
cally prevent its solution and assimilation. — Ibid. From Gazz. Med. Ital. Lom- 
bard-id, 4, 1852. 

15. On the Action of Iodine. — M. Bonnet has recently published two interest- 
ing papers on the action of iodine. In the first of these, he shows that iodine, 
when applied locally to ulcers or blistered surfaces, or injected into the cavi- 
ties of abscesses and serous membranes, becomes largely absorbed and excreted, 
being speedily detected in the urine and saliva. It may in this way be excreted 
by the urine to the extent of fifteen grains per diem, without in any way acting 
injuriously on the general health ; and to be therapeutically useful, such elimi- 
nation must be continued for six or eight weeks, as shown by the dark-blue 
colour produced in the urine by starch and chlorine without preliminary eva- 
poration. In this way, scrofulous ophthalmia may be effectually cured by 
dressing a blistered surface, remote from the eyes, without the employment of 
any internal or local medication. The best of all the preparations for this 
mode of employment, is an ointment composed of iodine one part, iodide of 
potassium two parts, and lard thirty parts. 

In his other paper, M. Bonnet enters upon the consideration of the mode of 
action of iodine. He considers that it only operates beneficially in proportion 
to the amount of eliminatory action it gives rise to, in which respect it sur- 
passes most other substances ; or at all events, our chemical reagents enable us 
better to trace its operation. In the diseases in which the iodine proves useful, 
there is also morbid material to eliminate, and by catalytic action the economy 



196 



Progress of the Medical Sciences. 



[Jan. 



is enabled to effect this by the eliminatory effort excited by the iodine. The 
greater activity of elimination is followed by a greater activity in the renova- 
tion of organic material. In consonance with this view, M. Bonnet observes 
— 1. If we are desirous of acting energetically on the economy by means of 
iodine, we must maintain this active twofold power of absorption and elimina- 
tion. The patients in whom he has found its use to be especially attended by 
increase of appetite and strength, are those suffering from large ulcers, in 
whom the tests exhibited the free excretion of the iodine by the urine ; while 
after each dressing of the ulcer with it, a temporary feeling of febrile heat of 
the skin was induced. — 2. The employment of the medicine should be asso- 
ciated with good hygienic measures, which render the organic renovation more 
active, and with such remedies as favour elimination. Thus, exercise, free 
exposure to the air, purgatives, and diaphoretics, second the effects of the 
iodine, as it in turn augments the influence of these agents. — 3. Iodine is no 
specific, and might be replaced by any substance which can easily penetrate 
into the economy, and of which the latter can easily rid itself again. Among 
such are sulphureous and terebinthine preparations, whose excretion is demon- 
strable, and probably the salts of mineral waters, which, however, our means 
are unable to detect in the excretions. However this may be, the most varied 
substances produce effects in common with iodine; and it is this common cha- 
racter of their mode of action which explains how they may be substituted for 
each other, when the power of exciting eliminatory action becomes enfeebled 
in either of them. —4. Notwithstanding this view of the eliminatory action of 
iodine, M. Bonnet believes the action of the iodides on the blood and fibrine, as 
shown by the experiments of Dumas and himself, must not be overlooked. 
When an alkaline iodide penetrates into the blood, it exerts a solvent action. 
If the fibrinous elements are in their normal fluid state, it may only render 
them less disposed to coagulate ; while if they are coagulated it dissolves them. 
Such coagulation exists within vessels that are the subject of inflammation, 
and beyond the vessels when effusion of lymph has taken place into the tissues. 
— Brit, and For. Med.-Chirurg. Rev. Oct. 1852, from Gaz. MMicale, Nos. 20, 
21, 22. 

16. On the Effects of Iodine on the Glandular System . — The question has been 
mooted, whether atrophy or absorption ever takes place in the glandular system 
from the use of iodine. In our preceding number (p. 495), we have given the re- 
sults of the large experience of Dr. L. Parker, which gives no countenance to the 
belief of the powers of iodine in promoting the absorption of glands ; and 
Dr. T. H. Silvester has recently [Proc. Med. and Surg. Journ. Sept. 1, 1852) 
adduced his observations, the result of many years' attention to this point, in 
support of the same conclusion. Dr. S. states that "from 1834 to 1844, a great 
many patients, suffering under secondary or tertiary syphilis, were admitted 
into St. Thomas's Hospital, more especially under the care of the late Dr. Wil- 
liams, who had gained a high reputation in the treatment of these morbid 
symptoms. Most of these patients came under my notice and particular ob- 
servation, and many of the remarkable cases were entered in my note-book ; 
but not one instance of atrophy or absorption of the large glands occurred in 
our experience. It was thought advisable, on the recommendation of Lugol, to 
test the efficacy of the iodide of potassium in scrofulous enlargement of the glands, 
and in order to give M. Lugol's method of treatment fair play, a most charac- 
teristic specimen of these affections was selected. A young woman, fat, florid, 
and fair, aged 18, was admitted with suppurating glands at the angle of the 
jaw, and others approaching suppuration, or hard and inflamed, extending to 
the chin, were conspicuously prominent. Eight grains of the iodide of potas- 
sium, in camphor mixture, were prescribed, and steadily administered, for 
nearly six months, without the slightest perceptible effect upon the scrofulous 
mass of glands, and she was presented in much the same state as at her ad- 
mission. Now, it happened that in this girl the breasts were largely developed, 
but no change was produced in their size by the treatment adopted for the scro- 
fulous ailment, notwithstanding the full dose, and prolonged administration of 
the iodide. 



1853.] 



Materia Medica and Pharmacy. 



197 



" There were at this period, before the treatment had become generally known, 
innumerable cases of syphilitic periostitis, in which the iodide of potassium 
was very successful, and yet we never witnessed atrophy or absorption of either 
the breast or testicle during the use of this medicine. A case of simple hyper- 
trophy of the breasts was then made the subject of experiment ; eight grains 
of the drug were taken, steadily and continuously, for three months, but no 
diminution of the mamma? took place. 

" A boy, aged 12, presented himself with immensely enlarged tonsils, and took 
the iodide nearly six months, without any impression having been made upon 
these organs. It would weary you to bring forward further illustration on this 
subject, and this negative kind of argument is, I am aware, not perfectly satis- 
factory, and may be destroyed by a single example of the positive power of the 
remedy in causing absorption of either the breast or testicle ; but ten years' 
observation in a large hospital failed to furnish me with a single proof in favour 
of the opinion that atrophy or absorption of the glandular system, in its nor- 
mal condition, arises from the use of iodine in any form. Experience as to 
the topical application of this powerful agent, involves an inquiry into the 
effects of friction, stimulation, protection, and warmth, and excludes all infer- 
ence as to its specific property. It must be confessed that enlarged testicles 
not unfrequently yield to its influence ; but it will be found, on inquiry, that in 
these cases the system had been contaminated by the syphilitic poison. The 
same remark is applicable to chronic induration of the inguinal glands. It is a 
very remarkable fact, that the swelling of the thyroid body, in common broncho- 
cele, vanishes under the internal use of iodine, especially the iodine of potas- 
sium. The rapidity and certainty of its removal are equalled only by that of the 
venereal node; and I have sometimes thought that there may be a vital elective 
attraction between the iodine and the lime, which latter forms the basis of the 
nodal tumour, and is, probably, the chief element in the thyroid enlargement. 

"It still remains to be explained how it happens that tumours, enlargement, 
and thickenings, of a nature other than have been noticed, disappear under the 
use, topical or internal, of the remedy in question : the explanation is un- 
doubtedly difficult; but I may be allowed to remark that there is an absence of 
permanency in the glands generally, the thyroid disappears spontaneously, the 
tonsils naturally at puberty, the breasts in advanced age, and sometimes the 
testicles and ovaries; and there are few practitioners who have not met with 
cases of absorption of the breasts and testicles from some unknown cause, and 
in morbid instances when no medicine has been taken. I have over and over 
again known and seen large swellings vanish under the long-continued applica- 
tion of a poultice, or wet lint and oil silk ; and an equal number of failures, 
where iodine, internallv and externally, was had recourse to, have occurred 
to me." 

17. New Mode of employing Iodine. — M. Hanson has suggested, that when 
iodine is to be applied to a local tumour, as to a goitre, it should not be rubbed 
in at once — a practice which often irritates the skin excessively — but that it 
should be placed between two layers of cotton wool, sewed in a bag, and tied 
directly over the part. The vapour of the iodine rapidly penetrates through 
the bag, and stains both the skin and the linen. To prevent this, a thin sheet 
of gutta percha or gummed silk is placed over the bag. It is indispensable to 
put the iodine between two layers of wadding ; if placed merely in a bag, it 
passes through and blisters the surface like ammonia. Applied in this way, 
iodine enters the system with great rapidity, and appears in all the escretions. 
— Med. Times and Gaz. Sept. 4, from Presse Medicate. 

18. Urea as a Diuretic. — Dr. T. H. Taxxer states {Med. Times and Gaz. May 
8, 1852), that he has employed urea as a diuretic and found it very efficient, 
and in no case has it given rise to any unpleasant symptoms. The ordinary 
dose, on being first used, is ten grains every six hours, dissolved in water fla- 
voured with syrup ; as its effects decrease the dose may be augmented to a 
scruple or more. At the same time, its action should be aided, as that of all 



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diuretics should be, by the free administration of diluents, as well as by keep- 
ing the skin moderately cool. 

In the first case in which Dr. T. used the urea, and the one in which he more 
particularly noted its effects, the quantity of urine secreted in the twenty-four 
hours previous to its administration was only fourteen ounces (high-coloured, 
acid, sp. gr. 1018), whereas, in the succeeding twenty-four hours, during which 
three doses of ten grains each were administered, the secretion amounted to 
forty-four ounces (pale, acid, sp. gr. 1013). The remedy was continued for the 
ensuing nine days, in doses of ten grains every six hours, during which period 
the urine varied in quantity from forty-nine to thirty-eight ounces. At the 
end of this time it was discontinued, as the dropsy had been temporarily re- 
moved; and, on again having recourse to it three weeks subsequently, its effects 
were as satisfactory. 

19. Chromic Acid as an Escliarotic — This acid is recommended by Dr. Hel- 
ler, a German physician, as a useful escharotic in severe cases, when properly 
and judiciously used. According to his experiments, all organic compounds 
are soluble in the readily deoxidizable chromic acid ; the smaller animals, such 
as mice and birds, were so completely dissolved by chromic acid in the space of 
fifteen to twenty minutes, that no traces even of their bones, skin, hair, claws, or 
teeth could be discovered; so that it would appear that this metallic acid is not 
only both a safe and gradual escharotic, but furnishes us with another rapid 
and efficient solvent for organic animal matter. — London Journ. Med. Sept. 
1852, from Annals of Pharmacy. 

20. Copahine-Mege. — This is the name of a peculiar preparation of copaiba 
and cubebs proposed by M, Jozeau, a French pharmacien in London, with 
which trials have lately been made in some of the London hospitals and in 
private practice, and it is said (Lancet, Nov. 6, 1852) with very satisfactory 
results. 

The peculiarity of M. Jozeau's saccharated capsules is stated to be that they 
are easy and agreeable to take, that they produce no nausea, sickness, or 
unpleasant purging, and that, when continued for a sufficient period, they cure 
gonorrhoea in a short time. Considering the insuperable dislike of some 
patients for copaiba, these, if verified by experience, are certainly most valu- 
able improvements. 

The following is the account given by M. Jozeau of the preparation of the 
copahine-mege, and the pathological facts which led to the peculiar manner of 
preparing this remedial agent: — 

It was noticed that such patients as were purged by the copaiba evacuated 
per anum large quantities of this drug in an unaltered state, their urine not 
containing any of it. These persons, though sometimes cured, generally had a 
relapse. Those, however, who were not purged became well more slowly, and 
had no recurrence of the disease ; their stools contained no copaiba, and their 
urine a great deal. From these facts it became evident that, in order to obtain 
regular and speedy effects, the copaiba should be made to undergo such modi- 
fications as to insure its more complete absorption into the system. Experi- 
ments were now instituted respecting the effects of the two principal substances 
contained in the copaiba — viz., the oil and the resin. These were separately 
tried. The oil produced a decidedly purgative effect ; the resin purged less ; 
but no complete cure was obtained by either substance taken separately. 

It was now pretty clear that both the resin and essential oil were indispens- 
able for obtaining curative effects, and the question arose how these could be 
modified so as to allow the stomach to digest them completely. This end was 
attained in surcharging the copaiba with oxygen, by means of nitric acid, the 
latter being added in proportions which varied according to the kind of copaiba 
acted upon. The nitric acid yields some of its oxygen to the essential oil, and 
the nitrogen is given off in the form of hyponitrous acid, by combining with 
the oxygen of the atmosphere. The copaiba thus treated is then well washed 
with water, until it no longer reddens litmus paper, and to it are added one- 
tenth part of cubebs in line powder, the same proportion of carbonate of soda, 



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199 



and one-sixteenth part of calcined magnesia. The mixture is allowed to stand 
until it is quite solidified, and in that state it is made into small masses. The 
latter are then carefully covered with sugar, to which a pleasant pink colour 
(coccus cacti) is given, and they then look like very pretty sugar-plums. 

To these saccharated capsules the name of copahine-mege was given, because 
the experiments had been made conjointly by M. Jozeau and M. Mege, and the 
latter had first thought of making the saccharated capsules. For lymphatic 
patients and delicate females a second mass was prepared, into which, besides 
the above-mentioned ingredients, some steel was made to enter. This is then 
a sort of martial preparation of copaiba. The doses are stated as follows : — 

When there is neither pain nor inflammation, five saccharated capsules are 
taken three times per diem. One capsule more is then given with each dose 
every subsequent day, the doses being thus increased until purging is pro- 
duced. Where there is pain or inflammation, these should first be treated by 
the surgeon in the manner he thinks the most advisable, and the copahine is to 
be commenced when acute symptoms have abated. It has been noticed that 
the martial capsules have effected a cure when the simple preparation has 
failed. 

21. Opianine, a New Base of Opium. — A Vienna apothecary was recently pre- 
paring morphia from a specimen of Egyptian opium; with the morphia which he 
obtained there was mixed another alkaloid, which he supposed to be narcotine, 
but which Dr. Hinterberger discovered to be a new base, and named opianine. 
It crystallizes in long, colourless, transparent, glistening needles. It contains 
sixty-six atoms of carbon, thirty-six of hydrogen, two of nitrogen, and twenty- 
one of oxygen. It is insoluble in water, and only very slightly soluble in boil- 
ing alcohol, from which it crystallizes on cooling. In its narcotic action, it 
appears strongly to resemble morphia. A parallel experiment was tried with 
two kittens (each six months old). To one was given two grains of pure morphia, 
and to the other an equal quantity of opianine. In the course of eight minutes 
both kittens presented the following symptoms : The pupils were very much 
dilated, the eyes were fixed, the tails were drawn inwards, and there was foam- 
ing at the mouth; afterwards, they walked unsteadily, trembled, and vomited, 
uttered occasional cries, and there was paralysis of the hind legs ; they finally 
lay down, could no longer be roused, and were insensible to the action of caustic 
ammonia. In the course of a day they both recovered. — Prov. Med. and Surg. 
Journal, Nov. 24, 1852. From Hinterberger, Sitz.-BericM der Wien. Akad., der 
Wissensch. Bd. 7, No. 3. 

22. Solvent for Disulphate of Quina. — Tartaric acid has been recommended 
as a better solvent for quince disulphas than diluted sulphuric acid, the agent 
usually employed to facilitate its solution in water ; one-third of the weight of 
the quina salt is a sufficient proportion of the tartaric acid to effect complete 
solution, which is by no means unpleasant to the taste, a great improvement 
on the intense bitterness of the ordinary solution of this salt made with diluted 
sulphuric acid. We have long thought it far more advisable to exhibit the 
alkaloids in combination with some vegetable organic acid, such as the tartaric, 
citric, etc., than as salts for the inorganic acids, in which latter state they are 
usually .employed. — Lond. Journ. Med. Sept. 1852. 

23. Pagliari's Pozmostatic. By M. Sedillot. — M. Pagliari, a pharmacien at 
Rome, professes to have discovered a styptic liquor of great power ; and several 
of the officers of the French army have testified to its efficacy. M. Sedillot has 
also, on several occasions, brought forward cases in corroboration ; and in the 
present paper he adduces additional ones, in some of which, considerable ves- 
sels, although not those of the first class, furnished the blood. He says that it 
has been objected that compression is employed by means of bandages and 
charpie ; but this is merely to prevent the coagula which form being removed 
from the mouths of the vessels ; and it has only to be continued for twenty-four 
or forty-eight hours. So little plastic is human blood, that compression alone, 



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[Jan. 



unaided by styptics, would have to be so prolonged and forcible, that it would 
risk the formation of ulcers or gangrene in the parts to which it was applied. 

M. Pagliari has now revealed the composition, which is as follows : Eight 
ounces of tincture of benzoin, one pound of alum, and ten pounds of water are 
boiled together for six hours in a glazed earthen vessel, the vaporized water 
being constantly replaced by hot water, so as not to interrupt the ebullition, 
and the resinous mass kept stirred round. The fluid is then filtered, and kept 
in stoppered b'ottles. It is limpid, slightly styptic in taste, aromatic in odour, 
and the colour of champagne. M. Hepp, of Strasburg, has substituted white 
resin for the benzoin. Every drop of this fluid poured into a glass containing 
human blood produces an instantaneous magma; and, by increasing the pro- 
portion of the styptic to the quantity of the blood, a dense, homogeneous, black- 
ish mass results. 

Many are the circumstances in which the surgeon may not be able to have 
recourse to the ligature, as in the case of friable arteries, secondary hemorrhage 
from deep-seated, painful, or inflamed wounds, the impossibility of seizing the 
artery, or where the hemorrhage results from numerous arterioles, which are 
too small or retracted, or from veins and capillary vessels. In all cases, in 
fact, where compression is now usually employed, without much benefit being 
expected to result from it, and often indeed proving useless or dangerous, this 
fluid seems indicated. — Brit, and For. Med.-Chirurg. Rev. Oct. 1852, from Bull, 
de Therap. torn. xlii. 



MEDICAL PATHOLOGY AND THERAPEUTICS, AND PRACTICAL 

MEDICINE. 

24. Curability of Insanity. — Dr. Forbes "Wixslow expresses (Lettsomian Lec- 
tures, Lancet, October 9, 1852) the following opinion on this interesting sub- 
ject:—'.' .. ■' y , ' , '\. ' V • YJV -'*TV" >- 

" I now speak from a somewhat enlarged experience, from much considera- 
tion of the matter, and I have no hesitation in affirming that, if brought within 
the sphere of medical treatment in the earlier stages, or even within a few 
months of the attack, insanity, unless the result of severe physical injury to the 
head, or connected with a peculiar conformation of chest and cranium, and an 
hereditary diathesis, is as easily curable as any other form of bodily disease for 
the treatment of which we apply the resources of our art. It is a lamentable error 
to suppose, and a dangerous, false, and unhappy doctrine to promulgate, that the 
disordered affections of the mind are not amenable to the recognized principles 
of medical science.* I again declare it to be my positive and deliberately formed 
opinion, that there are few diseases of equal magnitude so susceptible of suc- 
cessful medical treatment in the incipient form as those implicating the normal 
action of thought. The vast amount of incurable cases of insanity which crowd 
the wards of our national and private asylums, is pregnant with important 
truths. In the history of these unhappy persons — these lost and ruined minds 
— we read recorded the sad, melancholy, and lamentable results of either a 

* "You do not pretend to cure insanity?" exclaimed a gentleman of considerable 
intelligence to me, whilst detailing the particulars of a distressing attack occurring in 

a member of his own family; "for," he continued, "I heard Dr. positively declare 

in a public lecture, that 'he lamented to be obliged to say, that, in the cure of insanity, 
little or no good resulted from medical treatment.''" Sad and fatal doctrine! Whilst 
recently visiting Bethlehem Hospital, to see, at the request of their friends, two 
patients in that establishment, I heard a foreigner who had been inspecting the asy- 
lum observe, whilst talking of the medical treatment of insanity, that it was quite a 
mistake to have a portion of the asylum set apart for the "incurable patients." " The 
word 'incurable,' in reference to insanity," he continued, "should never be used." I 
would much prefer pinning my faith to the doctrine of the foreigner than to that of 
the English physician, who attempted to weaken our confidence in the curability of 
insanity by means of medicine. 



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Medical Pathology and Therapeutics. 



201 



total neglect of all efficient curative treatment at a period when it might have 
arrested the onward advance of the cerebral mischief, and maintained reason 
upon her seat ; or of the use of injudicious and unjustifiable measures under 
mistaken notions of the nature and pathology of the disease. In no class of 
affections is it so imperatively necessary to inculcate the importance of early 
and prompt treatment, as in the disorders of the brain affecting the manifesta- 
tions of the mind. I do not maintain that our curative agents are of no avail 
when the disease has passed beyond what is designated the " curable stage." 
My experience irresistibly leads to the conclusion that we have often in our 
power the means of curing insanity, even after it has been of some years' dura- 
tion, if we obtain a thorough appreciation of the physical and mental aspects 
of the case, and perseveringly and continuously apply remedial measures for 
its removal; but I cannot dwell too strongly upon the vital necessity of the 
early and prompt exhibition of curative means in the incipient stage of mental 
derangement : — 

' Principiis obsta : sero medicina paratur 
Cum mala per longas convaluere moras.' — Ovid." 

25. Pathology of Insanity. — The following are the conclusions at which Dr. 
Forbes Winslow has arrived in relation to this vexed subject: — 

" I believe insanity (I am now referring to persistent insanity, not those 
transient and evanescent forms of disturbed mind occasionally witnessed) to 
be the result of a specific morbid action of the hemispherical ganglia, ranging 
from irritation, passive and active congestion, up to positive and unmistakable 
inflammatory action. This state of the brain may be confined to one or two of 
the six layers composing the hemispherical ganglia ; but all the layers are 
generally more or less implicated, in conjunction with the tubular fibres pass- 
ing from the hemispheres through the vesicular neurine. This specific inflam- 
mation, from its incipient to the more advanced stage, is often associated with 
great vital and nervous depression. It is, like analogous inflammations of other 
structures, not often accompanied by much constitutional or febrile disturb- 
ance, unless it loses its specific features, and approximates in its character to 
the inflammation of active cerebritis or meningitis. This state of the hemi- 
spherical ganglia is frequently conjoined with active sanguineous circulation 
and congestion, both of the substance of the brain and its investing membranes. 
The morbid cerebral pathological phenomena — viz., the opacity of the arach- 
noid, the thickening of the dura mater, its adhesions to the cranium, the depo- 
sitions so often observed upon the convoluted surface of the hemispheres, and 
on the meninges, the hypertrophy, scirrhus, the cancerous affections, the indu- 
ration, the depositions of bony matter in the cerebral vessels and on the dura 
mater, the serous fluids in and the ulcerations upon the surface of the ventri- 
cles, the alterations in the size, consistence, colour, and chemical composition 
of the vesicular neurine and fibrous portion of the brain — are all, in my opinion, 
the results, the sequelse, more or less, of that specific inflammatory condition of 
the hemispherical ganglia to which I have referred. It does not necessarily 
follow that the fons et origo mali of insanity is invariably to be traced to the 
brain. The preliminary morbid action and irritation are often situated in the 
heart, the stomach, the liver, the bowels, the lungs, or the kidneys, the brain 
being secondarily affected; nevertheless, in all cases inducing actual insanity, 
the hemispherical ganglia are involved in the morbid action." — Lettsomian Lec- 
tures, Lancet, October 9, 1852. 

26. Medical Treatment of Insanity. — The following interesting and instructive 
remarks on this subject, by Dr. Forbes Winslow, are well worthy of atten- 
tion : — 

"In regard to the treatment of acute mania, the important and much liti- 
gated question at issue among practitioners of all countries, is that relating to 
the propriety of depletion. Need I direct your attention to the conflicting and 
contradictory opinions entertained by eminent writers on this important and 
much vexed therapeutical point? Whilst some practitioners of great repute 
and enlarged experience fearlessly recommend copious general depletion fur 



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the treatment of insanity, and refer to cases in which this practice has been 
attended with the happiest results, others, equally eminent, and as much enti- 
tled to our respect, denounce the lancet as a most fatally dangerous weapon, 
and shudder at the suggestion of abstracting, even locally, the smallest quan- 
tity of blood. In avoiding Scylla, we must be cautious of being impelled into 
Charybdis. The error consists in a vain effort to discover a uniform rule of 
treatment, and attempting to propound some specific mode of procedure adapted 
to all cases. He who maintains that bloodletting is never to be adopted in 
the treatment of mania, without reference to its character, its origin, the pecu- 
liar constitution of the patient, and the existence of local physical morbid con- 
ditions, which may be materially modifying the disease, and giving active 
development to delusive impressions, is not a safe practitioner. Neither would 
I confide in the judgment of the physician who would, in every case of violent 
maniacal excitement, attempt to tranquillize the patient by either general or 
local depletion. 

"In attacks of insanity, when the symptoms are acute, the patients young 
and plethoric, the habitual secretions suppressed, the head hot and painful, the 
eyes intolerant of light, the conjunctivae injected, the pupils contracted, the 
pulse rapid and hard, and the paroxysm sudden in its development, one gene- 
ral bleeding will often arrest the progress of the cerebral mischief, greatly 
facilitate the application of other remedies, and ultimately promote recovery. 
In proportion as the symptoms of ordinary insanity approach those of phrenitis, 
shall we be justified in the use of general depletion. Although it is only occa- 
sionally, in instances presenting peculiar characteristic features — cases occur- 
ring in the higher ranks of life, where the patient has been in the habit of 
living above par, and is of a sanguineous temperament — that we are justified in 
having recourse to the lancet, there is a large class of recent cases presenting 
themselves in the asylums for the insane, both public and private, in the treat- 
ment of which we should be guilty of culpable and cruel negligence, if we were 
to omit to relieve the cerebral symptoms by means of the local abstraction of 
blood. It is, alas ! the fashion and caprice of the day to recklessly decry the 
application of cupping-glasses or of leeches in the treatment of insanity, in con- 
sequence, I think, of the slavish deference shown to the opinions of a few 
French pathologists of eminence, who have, by their indiscriminate denuncia- 
tion of all depletion, frightened us into submission, and compelled us to do vio- 
lence to our own judgment. The local abstraction of blood is, in the hands of 
the discreet and judicious practitioner, a powerful curative agent; and yet it is 
the practice of some men, and men, too, of position, to discard altogether the 
remedy. 

" I will briefly refer to the kind of case in which the local abstraction of blood 
will be found most beneficial, if proper regard be had to the temperament, 
constitutional condition, and the local circumstances modifying the character 
of the attack. In insanity, when the exacerbations occur at the menstrual 
period, cozteris 'paribus, leeches to the vulva and thighs, with the use of the 
foot-bath, and the exhibition of aloetic purgatives, will be attended by the most 
favourable results. In irregular and obstructed menstruation, the local ab- 
straction of blood will be very serviceable. In suppressed hemorrhoids, leeches 
to the neighbourhood of the sphincter ani will greatly benefit in unloading the 
hemorrhoidal vessels, and relieve the brain of undue excitement. In cases of 
nymphomania, leeches to the vulva are indicated, and have been known to 
greatly benefit. In cases of intermittent insanity, the paroxysm may often be 
cut short by relieving the overloaded state of the vessels of the head by means 
of cupping or the application of leeches. In some instances, I have tried Dr. 
Wigan's plan, and have applied leeches to the Schneiderian membrane, par- 
ticularly for the treatment of insanity of early life, and connected with conduct 
evidently the effect of cerebral irritation. I have seen this mode of procedure 
of essential benefit in persons of plethoric constitution and of sanguineous tem- 
perament. Occasionally, the insanity is found to be associated with active 
visceral disease, or with hypertrophy and other affections of the heart. Under 
these circumstances, when there exists great tenderness over the region of any 
of the visceral organs, and we are satisfied, by a careful stethoscopic examina- 



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Medical Pathology and Therapeutics. 



203 



tion, that hypertrophy of the heart is present, leeches applied over the seat of 
the local mischief, conjoined with other appropriate treatment, will materially 
aid us in subduing the maniacal affection. In cases of illusions of hearing, or 
of vision, it will often be necessary to apply leeches behind the ears, or over 
the superciliary ridges. I have known this practice entirely remove the mor- 
bid illusions which had been embittering the person's life. 

"But apart entirely from the local affections to which I have referred, for the 
treatment of idiopathic insanity, apparently without any complications, or 
modified by any of the associated diseases, the careful and temperate local 
abstraction of blood, when general depletion is inadmissible, will often mate- 
rially shorten the duration of an attack of insanity, and restore the mind to a 
healthy condition. I am anxious to record my favourable opinion of this mode 
of treatment, because I have witnessed so many tsad results from an opposite 
timid and reprehensible neglect of the means placed within our power for the 
treatment of the varied forms and degrees of mental derangement. Sad conse- 
quences have undoubtedly followed the indiscriminate use of depletory mea- 
sures ; the presence of violent mental excitement has occasionally led the 
practitioner to the conclusion that the disease was of an active character ; and 
in the attempt to allay the undue cerebral excitement by means of antiphlo- 
gistic measures, the patient has sunk into incurable and hopeless dementia. 
But whilst recognizing an anaemic class of cases, where great excitement is 
often associated with loss of nervous and vital power, we must be cautious in 
permitting serious disease to be creeping stealthily on in the brain, no effort 
being made to relieve the congested cerebral vessels or inflamed tissue, until 
serious, disorganization has taken place in the delicate structure of the vesicu- 
lar matter, and the patient is forever lost. In the treatment of acute mania, 
the remedy next in importance to cautious depletion is that of prolonged hot 
baths. To Dr. Brierre de Boismont, of Paris, at whose excellent institution I 
first witnessed the application of this remedial agent, the profession is indebted 
for reviving a practice which had long fallen into disrepute. In the treatment of 
acute mania, the prolonged hot baths will be found of the most essential ser- 
vice. Dr. Brierre de Boismont has recorded the history of sixty-one of seventy- 
two cases that were subjected to this mode of treatment. Three-fourths of this 
number were cured in a week, and the remainder in a fortnight. The patients 
remain from eight to ten and fifteen hours in warm baths, whilst a current of 
cold water is continually poured over the head ; the temperature of these baths 
is from 82° to 86° Fahr. ; the affusions 60° Fahr. Among the therapeutic effects 
of these baths, Dr. B. de Boismont reckons a diminution of the circulation and 
respiration, relaxation of the skin, alleviation of thirst, the introduction of a 
considerable quantity of water into the economy, an abundant discharge of 
limpid urine, a tendency to sleep, a state of repose. This mode of treatment is 
said to be ineffectual in cases of periodic intermittent mania, in mania beginning 
with great mental impairment, or associated with epilepsy or general paralysis. 
The result of my own experience of this plan of treatment has produced a very 
favourable impression upon my mind, and I think it is entitled to a fair trial 
in all our public asylums where they admit acute and recent cases. 

V In some forms of acute mania it is desirable, as a substitute for depletion, 
to diminish the activity of the circulation by the exhibition of nauseating doses 
of the tartrate of antimony ; it may be serviceably combined with the tinctures 
of digitalis and hyoscyamus. This remedy, however, requires careful watch- 
ing, as it often has been known to suddenly reduce the vital powers to a low 
ebb, and extinguish life. It will be found beneficial in proportion to the recent 
character of the case, and the positive activity of the cerebral circulation. The 
tincture of digitalis was formerly in great repute as an anti-maniacal remedy ; 
the experience of late years has not encouraged us in administering it in the 
doses prescribed by some of the old writers ; nevertheless, it is a useful agent, 
and occasionally proves a valuable auxiliary in the hand of the practitioner 
who carefully watches its operation. 

" For the cure of the acute forms of insanity the douche bath has been much 
lauded ; but this remedy is now rarely used in British asylums. I have occa- 
sionally seen benefit derived from its exhibition, but it requires great caution 



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[Jan. 



in its use. A patient has been subjected, whilst in a paroxysm of acute deli- 
rium, to the douche bath, and has sunk almost immediately into incurable 
idiocy ! The physical shock has occasionally been known to produce a good 
moral impression. For illustration : a patient imagined himself emperor of the 
world, and would not allow any one to address him by any other title. The 
immediate application of the douche bath destroyed his idea of royal dignity, 
and he was willing to admit that he had never been, nor was at any time a 
regal personage. A few hours subsequently the delusive impression returned 
in all its original force ; the douche bath was again had recourse to, and a 
second time the morbid impression vanished ; by a series of baths he was 
restored to sanity, and after his complete recovery, when the particulars of his 
case were placed before him, he observed, 'Why did you not whip me, and 
beat this nonsense out of my head ? I wonder how you could have borne with 
my folly, or I have been guilty of such contemptible arrogance and obstinacy.' 
As a substitute for the douche, the shower bath is often used with great bene- 
fit, particularly in certain forms of melancholia, associated with nervous depres- 
sion and general debility. In cases of melancholia, or other kinds of chronic 
insanity connected with a congested state of the liver, the nitro-muriatic bath 
will occasionally do much good. In a few instances, I have noticed marked 
benefit from the use of Bertolini's sedative bath, composed of henbane two 
pounds, and equal parts of hemlock and cherry-laurel leaves, well infused in a 
sufficient quantity of hot water. But the simple hot bath in certain conditions 
of the nervous system, particularly in some forms of suicidal mania, is of the 
utmost benefit. A warm bath a short period before retiring to rest, bathing 
the head at the same time with cold water, particularly if the scalp be unnatu- 
rally hot, will often insure a quiet and composed night when no description of 
sedative, however potent its character and dose, would influence the system. 

"In the early stage of insanity, and throughout its whole Course, the bowels 
are often in an obstinately constipated condition. The concentration of nerv- 
ous energy in the brain appears to interfere with that supply which should 
proceed to other structures ; consequently, there appear to be a want of healthy 
sensibility in the mucous membrane of the bowels and an interruption of the 
peristaltic action of the intestinal canal. There is no class of agents which act 
bo certainly and effectually in relieving the mind when under the influence of 
depressing emotion, as cathartics. The ancients considered hellebore as a 
specific in certain forms of melancholia. In the hands of modern practitioners 
it has not been found to merit the high encomiums which have been passed 
upon it. It is important in every case of insanity, but particularly in the acute 
stages of mental derangement, to act powerfully upon the bowels by means of 
a succession of brisk cathartics. The bowels are often found gorged with fecal 
matter, and immediate relief often follows the administration of two or three 
doses of calomel and colocynth, or of croton oil. It will often be necessary to 
assist the operation of the cathartics by means of enemata. In hysterical and 
some other forms of insanity, there is always a disposition on the part of the 
patient resolutely to resist the calls of nature, and, knowing this peculiarity, 
we must carefully watch the condition of the bowels, otherwise serious mecha- 
nical obstructions may ensue, followed by intractable diseases of the rectum. 
Insanity is often associated with gastric and intestinal disease, with an irri- 
table condition of the mucous membrane of the alimentary canal ; and, in such 
cases, although it is important to relieve the bowels and prevent them from 
being constipated, we must bear in mind that the injudicious exhibition of 
irritating drastic cathartics may aggravate the mental disease, by increasing 
the gastric and intestinal irritation, and thus do permanent and irremediable 
mischief. Much injury may arise from the indiscriminate and injudicious 
administration of cathartics. In insanity associated with menstrual obstruc- 
tions, it will be necessary to exhibit the class of purgatives known to act spe- 
cifically upon the lower bowel ; consequently, aloetic cathartics, such as the 
compound decoction of aloes, are found of most service in these cases. In 
plethoric habits, when there is a marked determination of blood to the head, 
no medicine will relieve so speedily as active doses of the compound powder of 
jalap. 



1853.] 



Medical Pathology and Therapeutics. 



205 



" In the treatment of insanity, the class of medicines termed sedative play an 
important part. If exhibited with judgment, the most gratifying results often 
follow their continuous and persevering administration. The sedative treatment 
of insanity is a subject of itself, and I quite despair of touching even upon the 
confines of the many interesting and important points involved in the conside- 
ration of this division of my lecture. In insanity unassociated with active 
cerebral circulation, congestion, or paralysis, or after the head symptoms have 
been relieved by the local abstraction of blood and the administration of appro- 
priate medicine, the exhibition of sedatives will be followed by the most bene- 
ficial results. In recent cases they are generally inadmissible, except in 
delirium tremens and puerperal insanity, and other forms of derangement 
analogous in their pathological character and symptoms to these affections. 
In chronic insanity, in melancholia unconnected with abdominal repletion, or 
visceral disease, the persevering use of sedatives in various combinations will 
often re-establish sanity, when no other course of treatment is likely to be suc- 
cessful in dispelling the illusive impressions, or raising the drooping and 
desponding spirits. Battley's solution, the tincture of opium, the meconite, 
acetate, and hydrochlorate of morphia, the preparations of hyoscyamus, conium, 
stramonium, camphor, hops, aconite, ether, chloroform, hydrocyanic acid, In- 
dian hemp, are all of great and essential service if administered with judgment 
and sagacity. In suicidal insanity, when local cerebral congestion is absent, 
and the general health and secretions are in good condition, the meconite and 
hydrochlorate of morphia often act like a charm, if uninterruptedly and perse- 
veringhj given until the nervous system is completely under its influence. I 
have witnessed the most distressing attacks of suicidal mania yield to this 
treatment, when every other system had failed. I could cite the particulars of 
numerous cases of this form of insanity radically cured by the occasional local 
abstraction of blood from the head, the administration of alteratives, the warm 
bath, and sedatives. In the use of this powerful curative agent, our success 
will often depend upon a ready adaptation of the kind of sedative to the descrip- 
tion of case in which it may be deemed admissible, and a judicious com bination of 
various kinds of sedatives. I do not think we pay sufficient attention to such 
combinations. I have often seen an apparently incurable and unmanageable 
case yield to several kinds of sedatives combined, when it resisted the opera- 
tion of any one or two. The extract of conium is often of service in cases of 
insanity combined with epilepsy ; conjoined with mineral tonics, conium is 
occasionally of benefit, particularly in melancholia connected with chronic dis- 
ease of the digestive organs and with neuralgia. In cases of uterine irritation, 
I have seen great good result from the combination of hops, camphor, and 
hyoscyamus. In illusions of vision, belladonna, commencing with quarter-grain 
doses, will be found a useful remedy. In insanity complicated with dysme- 
norrhea, the combination of camphor with hyoscyamus, opium, or conium 
may be given with great advantage. The hydrochlorate of morphia, in union 
with dilute hydrochloric acid, is said to be useful in cases where the sedative 
treatment is desirable. I am often in the habit of exhibiting sedatives and 
tonics in a state of combination, particularly conium with iron, opium with 
quinine, or with the infusion or compound decoction of cinchona. In debility, 
with irritability of the nervous system, accompanied by restlessness, Battley's 
solution, with the preparations of cinchona, will often prove of great benefit. 
The tincture of sumbul I have occasionally administered, and I think with, 
advantage, in paroxysmal or convulsive forms of insanity. I have given to the 
extent of one to two drachms for a dose. In hysterical derangement, the tinc- 
ture of Indian hemp will occasionally allay the excitement, and produce sleep 
more rapidly than any other form of sedative. The valerianate of zinc has not 
answered the expectations of those who have spoken so highly of its medicinal 
virtues. Tincture of opium with camphor, and the tartrate of antimony, is an 
excellent combination in cases of doubtful cerebral congestion. Tincture of 
hops in doses of from one to four drachms, it will be necessary to give when 
no other formulae are admissible. As a mild form of sedative, compound ipe- 
cacuanha powder is occasionally recommended ; but a good substitute for 
Dover's powder is a pill composed of opium, ipecacuanha, and soap. 
No. XLIX.— Jan. 1853. 14 



206 



Progress of the Medical Sciences, 



[Jan. 



" In treating the more chronic forms of insanity, particularly melancholia, it 
will be essential to bear in mind that they are difficult of cure, because, owing 
to the slow, obscure, and insidious character of the disease, the mental affec- 
tion has been of some duration before the attention of the practitioner has 
been directed to its existence. As this form of derangement generally exhibits 
itself in trifling perversions of the affections and propensities, leading to little 
acts of extravagance and irregularity of conduct, associated with great depres- 
sion, we often find the attack has existed some years before a necessity is felt 
for any medical advice or treatment — perhaps a suicidal propensity has mani- 
fested itself, this being the first apparent overt act of the insanity. 

" It is necessary, before suggesting any course of treatment in melancholia, 
to ascertain whether any latent visceral disease be present. Occasionally, the 
local irritation will be found either in the liver, the stomach, and bowels, and 
in women the uterine functions are frequently disordered. In the religious 
and other forms of melancholia in females, the delusive ideas are often asso- 
ciated with uterine irritation ; and under such circumstances, if actual physical 
derangement of an active character exists in this organ, the best treatment 
will be, the application of leeches to the neighbourhood of the uterus, com- 
bined with warm hip-baths, sedatives, and mineral tonics. In cases of melan- 
cholia, the digestive functions are often much vitiated, the circulation languid, 
the skin cold and flaccid, and these symptoms being conjoined with a general 
loss of physical tone. Such patients require generous diet, good air, gentle 
exercise, and occasional stimuli. When dyspeptic symptoms are combined 
with an inactive state of the bowels, I have often administered the compound 
tincture of guaiacum with great benefit. It is important to watch the particu- 
lar features in these cases, and to improve the general health by the exhibition 
of mild alteratives and vegetable tonics, with alkalies. I have occasionally 
administered, with success, in this form of insanity, apparently associated 
with an abnormal condition of the nutrition of the brain, cod-liver oil, with 
preparations of iron. 

" My time will not admit of my submitting for your approval the treatment 
best adapted for those forms of mental disease associated with an atrophied or 
softened condition of the nervous matter. I think more is to be done for the cure 
of these cases than the writings of medical men would lead the student to sup- 
pose, particularly if the disease be seen and subjected to treatment in the early 
stages. I have recorded the details of several instances of cerebral disease, 
exhibiting all the legitimate features of ramollissement, and yielding to the per- 
severing administration of the preparations of iron, phosphorus, zinc, and 
strychnia, combined with generous living, and the occasional application of a 
leech behind the ear, should indications of cerebral congestion be present.* I 
have also derived benefit in these cases from the use of the milder forms of mer- 
curials, associated with cinchona. In cases of impairment of the mind, loss of 
memory, defective power of attention, occasional paroxysms of mental para- 
lysis, unconnected with lesions of the motor power, 1 have found a solution of 
the acetate of strychnine, and a solution of the phosphate of strychnine, of 
great advantage. 

" In some chronic forms of insanity, in dementia, and persistent monoma- 
nia, connected, as it was supposed, with morbid thickening of the dura mater, 
and with interstitial infiltration of the membrane, as well as with exudations 
upon its surface, I have occasionally had the head shaved, and have persever- 
ingly rubbed over the scalp a strong ointment of the iodide of potassium com- 
bined with strychnine. In other instances I have kept the head painted with 
the mixture of iodine. I have seen marked benefit from this mode of treat- 
ment. In several cases where the mental symptoms were supposed to be asso- 
ciated with effusions of serum, I have ordered the iodine to be applied externally, 
at the same time exhibiting minute doses of calomel, or mercury with chalk, to 
slightly affect the system : this, conjoined with occasional tonics, diuretics, and 
stimuli to support the vital powers and enable the patient to undergo this 

* In 1830, twenty-two years ago, my first observations on "Ramollissement of the 
Brain" were published in The Lancet. 



1853.] 



Medical Pathology and Therapeutics. 



207 



treatment,- is occasionally productive of considerable benefit, in cases appa- 
rently placed quite beyond the reach of improvement or cure. 

" I have only briefly spoken of two distressing and often unmanageable 
forms of insanity — viz., of suicidal mania, and of those cases where the patient 
obstinately refuses to take either food or medicine. In insanity associated 
with suicidal tendencies, it will be important to ascertain whether any cerebral 
congestion exist, as such is often the case. A few leeches applied to the head, 
followed by an active cathartic, will relieve the local irritation, and often dissi- 
pate the idea of self-destruction. In the absence of any positive active cerebral 
symptoms, the prolonged hot bath, and the persevering exhibition of some 
form of sedative, is the best treatment to be adopted. I have seen the suicidal 
impulse removed after the administration of a few doses of belladonna ; but the 
meconite and hydrochlorate of morphia, if given for a sufficient length of time, 
will, in the great majority of cases, distinct from actual incurable visceral or 
cerebral disease, effect a cure. Occasionally, the shower-bath and counter- 
irritation in the vicinity of the head, will aid us in re-establishing health. 
Cases sometimes present themselves where the patient determinately refuses to 
take either food or medicine. This character of case gives those who have the 
care of the insane much anxiety. The refusal of food may be connected with 
the determination to destroy life, or it may be associated with delusive impres- 
sions. I am inclined to believe that in the majority of these cases the symp- 
tom is the result of some local mischief remote from the brain, and sympatheti- 
cally affecting the organ of thought. Upon examination we often find, in these 
cases, great gastric derangement, obstinate constipation, considerable tender- 
ness upon pressure in the epigastric region, hepatic disease, the tongue foul, 
breath offensive, and other symptoms of derangement of the chylopoietic vis- 
cera. The determination to resist nourishment arises, under such circum- 
stances, from a positive loathing of food — a want of all inclination for it. I have 
seen cases of this description, where it has been deemed necessary, in order to 
prolong life, to introduce food forcibly into the stomach, speedily cured by the 
adoption of means for improving the state of the general health and digestive 
organs. Mild alteratives, vegetable tonics, blisters over the region of the 
stomach, if the patient complain of pain in that region upon pressure, the 
warm and shower bath, is the most successful treatment to adopt in cases 
connected with obvious visceral derangement. Instances sometimes occur, 
where the refusal of food is clearly traceable to a delusive impression — an hal- 
lucination of taste, which makes everything appear to the patient bitter, dis- 
gusting, and poisonous. The unhappy patient imagines that he is commanded, 
either by good or evil spirits, not to eat. These unhappy persons must be 
treated upon general principles, and the remedies be adapted to the peculiar 
character of each individual case. Under such hallucinations of taste, patients 
often swallow the most extraordinary articles. The case of a lunatic is recorded 
who imagined that his stomach required to be strengthened with iron. He 
was seized with inflammation of the oesophagus, of which he nearly died. He 
then confessed that he had swallowed the blade of a knife. After his death, 
there were found in his stomach seven oxidated lath nails, each two inches and 
a half long; thirty-three nails, two inches long; forty-nine smaller iron nails 
and rivets ; three pieces of wound-up iron wire ; an iron screw, an inch long ; 
a brass image of a saint ; part of the blade of a knife ; and other articles ; 
amounting in number to 100, and weighing about twenty ounces. It will be 
necessary, in cases like those to which I have been referring, to ascertain 
whether the determination not to eat is the effect of such perversions or hallu- 
cinations of taste. 

" The time will only admit of my alluding generally to the importance, as 
a principle of treatment, of the administration of tonic remedies, active exer- 
cise in the open air, and to good and generous living. It is rarely necessary, 
in the treatment of insanity, to deprive the patient of animal food. Individual 
cases occasionally come under our notice, in which it is necessary, for a time, 
to enforce a farinaceous diet; but such is not often our duty. Among paupers, 
insanity is frequently cured by the free use of good animal food, and a gene- 
rous supply of porter. Even when we are satisfied of the necessity of local 



208 



Progress of the Medical Sciences. 



[Jan. 



depletion, it will often be necessary to give wine, and allow the. patient a 
generous diet. 

" There are many other essential points in connection with this important, 
this vast subject, which I am reluctantly compelled to pass entirely over. 
"When I had resolved to bring this matter before the profession, I quite de- 
spaired, in the time allotted for one lecture, of being able to skim even upon 
the surface of the many deeply interesting points involved in the inquiry; but 
feeling — deeply, earnestly feeling — that, in relation to my own speciality, the 
subject of the medical treatment of insanity was of the first moment, of the 
most vital importance, to the profession as well as to the public, I did not hesi- 
tate in selecting this topic for one of my lectures, feeling assured that you 
would kindly make allowance for all imperfections, and generously appreciate 
the difficulties I had to encounter in concentrating in one short lecture a faint 
glimpse or shadow of a subject requiring for its successful exposition nine or 
ten lectures, equal in length to the one I have had the honour of reading this 
evening. I may have formed an extravagant and exaggerated conception of 
this subject, but I cannot close my eyes to the fatal consequences which have 
so often ensued from a belief in the incurability of insanity by medical means. 
In all grades of society, we witness the pernicious, the fatal, the disastrous 
effects of this dogma. We see it influencing the conduct of county magistrates 
in the architectural proportions, medical organization, and general arrange- 
ments of our great national asylums. We also perceive the consequences of 
the error operating in many of the private institutions for the treatment of the 
insane. Alas ! are we not compelled to confess, that many asylums for the 
insane constitute mere places of detention — model prisons — and not what 
government ought to insist upon making them — hospitals for the cure of 
the insane, under the government of medical officers, well trained, by prelimi- 
nary education, for their important vocation, acquainted with the philosophy 
of the human mind, and fitted by the character of their heart, as well as by 
their intellect, for the right performance of the solemn and responsible duties 
intrusted to them by the public and the legislature V' — Lancet, Oct. 16, 1852. 

27. New Researches on the Curability of Softening of the Brain. — Dr. Durand- 
Fardel observes that recovery from cerebral hemorrhage, and from softening 
of the brain are well-ascertained facts. There is, however, a difference in the 
progress of the two diseases. In hemorrhage, if the effused blood does not soon 
destroy life, cure or reparation commences by the absorption of the blood, the 
formation of a membrane, etc. The disease has attained its greatest develop- 
ment, and begins to diminish. The tendency of softening, on the other hand, 
is at first to increase ; and its cure or decrease is only after a succession of 
changes, of which hemorrhage offers no examples. Softening sometimes, indeed, 
stimulates the rapid development and the decreasing progress of hemorrhage ; 
but this is due to the general congestion which often at first accompanies it. 

When softening has passed into the chronic stage, the symptoms which 
attend it are connected, as in hemorrhage, with destruction of a portion of the 
cerebral fibres — due in one case to sudden laceration, and in the other to gra- 
dual disorganization. 

Dr. Durand-Fardel relates several cases, which lead him to the following 
conclusions: — 

Cerebral softening, when arrived at the chronic stage, may undergo cure like 
hemorrhagic effusion — by a process of limitation and absorption of the softened 
matter, analogous to the absorption of a clot. But this absorption, which at 
last produces ulcerations of the surface of the brain and cavities, or large losses 
of substance in the interior of the organ, succeeds to transformations, of which 
the most important are, yellow patches on the surface of the brain, and cellular 
infiltrations in the medullary substance. 

With regard to the symptoms, patients have during life presented symptoms 
of severe disease, from which they have entirely recovered, or of which they 
have retained traces exactly similar to those which attend the cicatrization of 
hemorrhagic clots. On post-mortem examination, we find softening, which 



1853.] 



Medical Pathology and Therapeutics. 



209 



sometimes seems to have remained stationary for a longer or shorter period, 
sometimes is transformed, and presents marks of reparation or cicatrization. 
Sometimes, again, the nature of the anatomical change is confirmed by the 
symptoms ; sometimes, the origin of the symptoms is proved by the nature of 
the change. 

The cases in which life has continued for years with slight paralysis, as if 
from a cured hemorrhagic clot, or those in which all symptoms have disap- 
peared after an uncertain period, prove, whatever be the character of the 
lesions subsequently found, that cerebral softening has not that fatal progress 
which is commonly attributed to it; that the prognosis usually formed ought 
to be modified; that, in an individual affected with cerebral softening, the 
symptoms may entirely disappear, or, more frequently, diminish and become 
limited. 

The author, in concluding, acknowledges that he is not the first who has 
pointed out the possibility of recovery from cerebral softening : this has 
already been done by Andral, Cruveilhier, Lallemand, Carswell, and Decham- 
bre.— Lond. Journ. Med. Sept. 1852, from Arch. Gen. de Mid. 1852. 

28. Eruptive Fevers. — Prof. Bennett, in a clinical lecture (Monthly Journ. 
Med. Sci. Oct. 1852), remarks : "There are certain diseases which, in an arbi- 
trary classification, may be considered as febrile eruptions, or as eruptive fevers. 
They comprehend especially scarlatina, erysipelas, variola, and rubeola. Occa- 
sionally roseola, herpes, or other cutaneous eruptions may be attended with 
fever, but they are separated from the others by their non-contagious or infec- 
tious nature. Plague and glanders, on the other hand, are true eruptive fevers ; 
and, with the others mentioned, obey certain laws, which may be shortly 
noticed. 

" 1. They may be infectious and contagious. By infection, is understood the 
power of being propagated through the inhalation of air tainted by the breath 
or perspiration of the affected person. By contagion, is understood communi- 
cation by actual contact. 

" 2. The present theory, with regard to the cause of these diseases, is, that it 
depends upon a morbid poison, a small quantity of which entering the blood 
produces in that fluid a peculiar change which is analogous to that of fermenta- 
tion. To distinguish this change in animal from what occurs in vegetable 
fluids, the term zymosis has been introduced by Mr. Farr (from £v[.i6u>, to fer- 
ment). 

" 3. Some of these animal poisons, if excluded from the air or carefully dried, 
will retain their communicating property for a longer or shorter time. This 
enables us to preserve matter for artificial inoculation. Hence also they have 
been supposed capable of attaching themselves to fomites — that is, substances 
of a rough surface or downy texture, such as wool, cotton, wearing apparel, 
dust, etc. It is on this theory that quarantine regulations are founded, the 
whole of which, together with the facts, real or supposed, that support them, 
require a thorough revision. 

" 4. All the animal poisons are distinguished by peculiarities in their mode of 
incubation and development. Thus a period of latency exists between expo- 
sure to the poison and accession of the fever, or first rigor. Again, the erup- 
tion appears at different periods after the fever is declared. Thus — 



Scarlatina, ' . . . 4 to 8 days . . 18 to 24 hours. 

Erysipelas, . . . 4 to 7 days . . 24 to 60 hours. 

Variola, . . . 8 to 14 days . . 48 hours. 

Eubeola, . . . 7 or 8 days . . 72 hours. 

"5. All the eruptive fevers, strictly so-called, invariably run a natural course, 
and cannot be cut short. It follows that — 

" 6. The treatment of febrile eruptions has for its object conducting these cases 
to a favourable termination. To this end exactly the same general rules are to 



Period of latency 
from 



Appears after first rigor 
in from 



210 



Progress of the Medical Sciences. 



[Jan. 



be followed as I previously gave when speaking of continued fever, and the 
same indications exist for the use of salines and laxatives, cold to the head, 
wine and stimulants, and regulation of the diet." 

29. Scarlatina. — Prof. Bennett, in a clinical lecture {Monthly Journ. Med. 
Sci. Oct. 1852), after relating three cases of this disease, remarks : " Of all the 
eruptive fevers, scarlatina is the most rapid in its invasion, and the most simple 
in its course. Great watchfulness is therefore demanded on the part of the 
practitioner, especially when the crisis is to be expected, so that if the pulse 
falters, and prostration comes on rapidly, he may be prepared to meet it. Per- 
haps, also, scarlatina is the most infectious of the eruptive fevers, so that com- 
plete separation of the patient from the other members of a young family is 
at all times to be insisted on as soon as possible. 

"A chief peculiarity of scarlatina is, that, in addition to the general fever 
and characteristic eruption, the tonsils and mucous membrane of the mouth 
and pharynx are also inflamed. This occasions difficulty of deglutition, with 
soreness of the throat, symptoms which require for relief topical remedies — 
such as leeches, fomentations, astringent and slightly acid gargles, or a linctus, 
etc. If sloughing or ulceration occur, the application of the stronger acids, or 
the nitrate of silver, is often necessary. The difficulty of deglutition sometimes 
impedes the introduction of food into the stomach, and in this way assists in 
producing prostration, and prevents the administration of stimulants or medi- 
cine. It may also, in severe cases, impede respiration, and assist in producing 
asphyxia directly. A fatal result, however, when it does occur during the 
primary attack of scarlatina, is generally dependent on the same causes which 
induce it in typhus fever — namely, congestion of the brain, as indicated by 
delirium, passing into coma, and followed by prostration of the vital powers. 
In addition to the throat complication, there are various others, all of which 
may require a special treatment. In the vast majority of cases, however, a 
general treatment, directed in the first place to subduing the excess of fever, 
and afterwards to supporting the strength, is indicated. 

" Many efforts have been made by different practitioners to check or modify 
the intensity of the disease by administering various drugs, or carrying out 
particular kinds of treatment. Hence, during certain epidemics, or in its 
visitations to particular educational institutions, various practitioners have 
been sanguine enough to believe that their especial mode of practice has been 
more successful than any other. I do not consider it necessary to direct your 
attention to the numerous plans which have been thus proposed, because all of 
them have been only partial in their operation, and no one of them has been 
more successful than another. You must remember that the causes of scar- 
latina are as mysterious and unknown as are those producing every kind of 
fever ; and that its fatality, like that of fever, is to be traced to constitutional 
circumstances in individuals, to unhealthy localities, or to the so-called type of 
the particular epidemic. Nothing, therefore, is more difficult under such cir- 
cumstances than to judge whether the non-fatality observed at one time, or in 
a certain establishment, is referable to this or that practice. At all events, I 
have been unable to satisfy myself that any general rule of empirical or rational 
practice is to be derived from the contradictory accounts which have from time 
to time been made public on this subject. 

" The most recent system of treatment which has been brought forward is that 
recommended by Dr. Andrew Wood ; and I notice it in deference to the great 
experience that gentleman has acquired from his position as physician to Heriot's 
Hospital and other educational establishments in this city, which have been 
attacked by numerous epidemics of the disease. He considers that the most 
efficient and safe method of treatment consists in acting powerfully on the 
skin, with a view of thereby assisting nature to eliminate the scarlatinal poi- 
son from the system. As ordinary diaphoretics frequently fail, he has recourse 
to the following method: Several common beer bottles, containing very hot 
water, are placed in long worsted stockings, or long narrow flannel bags, 
wrung out of water as hot as can be borne. These are to be laid along side the 



1853.] 



Medical Pathology and Therapeutics. 



211 



patient, but not in contact with the skin. One on each side, and cne between 
the legs, will generally be sufficient; but more may be used if deemed neces- 
sary. The patient is to lie between the blankets (the head of course being out- 
side) during the application of the bottles, and for several hours afterwards. 
In the course of from ten minutes to half an hour, the patient is thrown into a 
most profuse perspiration, when the stockings may be removed. In mild cases, 
the effect is easily kept up by means of draughts of cold water, and if neces- 
sary, by the use of two drachm-doses of sp. mindereri every two hours. In 
severe cases, where the pulse is very rapid — the beats running into each other — 
where the eruption is either absent or only partial, or of a dusky purplish hue — ■ 
where the surface is cold — where there is sickness or tendency to diarrhoea — 
where the throat is aphthous or ulcerated, and the cervical glands swollen, then 
he follows up the use of the vapour-bath by four or five grain doses of carbon- 
ate of ammonia, repeated every three or four hours. Should this be vomited, 
then brandy may be given in doses proportioned to the age of the patients. 
Carbonate of ammonia he considers to act beneficially: 1st, by supporting the 
powers of life; 2d, by assisting the development of the eruption; and 3d, by 
acting on the skin and kidneys. Where the vapour-bath was used early in the 
disease, and its use continued daily, or even twice or thrice a day, according to 
circumstances, he has found that the chance of severe sore throat was greatly 
obviated. In regard to supervening dropsy, he considers that, by the use of 
the vapour-bath, with the other necessary precautions as to exposure, diet, etc., 
its recurrence is rendered much more rare. In the treatment of the dropsical 
cases, it was also very useful, and even might be trusted to entirely in some 
cases. Dr. Wood also condemns all depleting treatment, and even purgatives, 
during the first ten days, as not only not required, but positively dangerous, as 
tending to interfere with the development of the eruption. In the later 
stages, as well as in the dropsy, however, he thinks purgatives are often bene- 
ficial. 

" The general plan of this treatment appears to be so far rational that its 
object is to hurry forward the disease by applying damp heat to the skin, and 
by thus assisting nature to make her operations more perfect than they might 
otherwise be. In other words, by rendering the febrile eruption more com- 
plete, diminish the risk of its leaving behind it a tendency to subsequent dis- 
ease. Whether this plan as a whole will, in practice, prove more extensively 
beneficial than any other, can only be determined by an extensive trial and 
careful comparison of the results. I propose, however, to try it in the next 
case which enters the wards." 

The Professor subsequently tried this plan of treatment, and offers the fol- 
lowing observations in regard to it: "On the first occasion the vapour-bath 
produced little effect, but on the second copious diaphoresis was induced. Yet 
it so happens that the disease, instead of being shortened or rendered milder, 
was unusually prolonged, and was followed by rheumatism, dropsy of the inferior 
extremities, and by pericardial effusion. The febrile symptoms terminated by 
critical depositions in the urine so late as the fifty-second day. Although ad- 
mitted June 29, she was not strong enough to be dismissed from the infirmary 
until September 7th. This was certainly an unfortunate case to commence the 
trial of a new treatment with; and yet observe, the girl had been always 
healthy, and there was nothing to indicate at the commencement that the se- 
quelae would be so severe or so prolonged. It would be absurd, however, to 
suppose that we can test the value of any kind of treatment by one case. I 
only give you the facts as I find them. I shall certainly continue the practice 
until I am satisfied either that it is really beneficial ; or, on the other hand, no 
better than the simple treatment formerly pursued. 

" It has frequently been observed, that the urine in scarlatina, especially when 
dropsy supervenes, becomes albuminous. Dr. James W. Begbie, who has tested 
the urine in a considerable number of cases of this disease, considers its pres- 
ence almost uniform. Aware of what he has written on this subject, I gave 
directions to the clinical clerk to test the urine daily, which was done during 
the whole time the patient was in the house. The result was, that on no one 
single occasion was the urine in the slightest degree albuminous. Even on the 



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day when a slight deposit appeared, which was made up of casts and epithelium 
of the tubes, the report says, 'No albumen in the urine when tested by heat 
and nitric acid/ This coagulability of the urine, as well as various deposits, 
which appear in it on critical days, must be considered as an evidence of the 
excretion of the morbid products which have circulated in the blood. Hence it 
is common, not only in scarlatina, but in all inflammatory affections, as well as 
fevers. This point you must have seen me very observant of in watching for 
the resolution of inflammations and fever at the bedside. For the theory of 
its occurrence, I must refer you to my 1 Treatise on Inflammation/ p. 65, and 
to a former lecture on ' Exudation.' — [See this Journal for Oct. 1850, p. 479.] It 
sometimes happens, however, that the critical discharge is comparatively slight, 
and that the organic elements are not dissolved so as to constitute fluid albu- 
men. This appears to have occurred in the present case, for whilst morpho- 
logical evidence of the crisis existed in the urine, in the form of cells and casts, 
it is distinctly stated no albumen could be detected by heat and nitric acid. 
Yet the girl's convalescence commenced from that day." 

30. On an Epidemic " Suette MUiaire t v in the Herault. — A paper on this sub- 
ject, by Dr. Swaine, was read at the first meeting of the third session of the 
Epidemiological Society, of which the following is an abstract: — 

Dr. Swaine begins by defining suette miliaire as an epidemic fever of a remit- 
tent type and a typhoid form, attended by profuse sweating, and for the most 
part with an extensive eruption of miliary vesicles. Dr. Swaine stated that he 
believed that the disease, in its present form, had been known on the Continent 
before the commencement of the eighteenth century, and accurately described 
by Bellot during the fourth decennium of last century. It had recurred, from 
time to time, in various parts of France, always selecting damp, poverty- 
stricken, and ill-drained localities for its visitation. In 1821, the centre of 
France became a prey to its ravages, and that patient and acute observer, M. 
Rayer, was then commissioned by his government to investigate and report 
upon the disease. This report was most comprehensive and most welcome. 
Unfortunately, however, it appeared under the banner of Broussais-isme, which 
deprives it of a portion of its value at the present day. It was not until 1851, 
that the Herault became visited with this pestilence. It first broke out in a 
village situate on the declivity of a hill, sheltered by mountains, more or less 
elevated, from all but the south wind, which reaches it with the malaria cf a 
marsh district on its wings. The village is dirty and viciously drained, the 
refuse of many small distilleries contributing to its insalubrity. The inhabit- 
ants are poor and prejudiced. Here the disease appeared spontaneously in the 
early spring. Many were attacked, and a few died. To the east of this village 
rises a lofty volcanic plateau, twelve miles long and, two broad. Over this 
range the disease seemed to make a leap, attacking, secondly, with great and 
deadly violence, a village lying at the other extremity of the plateau. Although 
without any regular order in its march, the epidemic afterwards attacked, in 
succession, all the villages and towns situated around the base of the said pla- 
teau (les Causes), and in fact seemed to confine itself almost entirely to one 
hydrographic basin, the bed of the River Herault and of certain of its tributa- 
ries. No facts are recorded which render it very probable that the disease is 
propagated by contagion. It is, however, stated that it sometimes passed from 
village to village, in the teeth of the prevailing winds. The people, however, 
and even the rural practitioners, mostly believed in contagion, and it required 
nothing less than a scenic display on the part of a government commissioner to 
reassure the panic-stricken inhabitants of the affected district on this point. 
The etiology of the disease remains obscure. A specific telluric influence 
must be supposed to be superadded to the general miasmatic tendency of the 
affected communes. The epidemic generally sets in in early spring, when the 
peasantry, male and female, are engaged in laborious field-work under a broil- 
ing sun, and often with a piercing wind blowing upon them from the snow 
mountains of the Cevennes ; whilst the sweating method of treatment is at all 
times, and for the cure of nearly all diseases, carried to its utmost limits. The 



1853.] 



Medical Pathology and Therapeutics. 



213 



nature of the disease is, if possible, still more obscure. French physicians 
have uniformly applied the pathological theories current in their own day to 
the explanation of this disease. Dr. Swaine felt more inclined to adopt Prout's 
view of analogous fevers attended with profuse sweating — namely, that an 
excessive quantity of lactic acid is generated within the system and excreted 
by diaphoresis. The almost exclusively vegetable and milk diet of the pea- 
santry in the Herault, seems to Dr. Swaine to favour this assumption ; and he 
thinks that in the so-termed malignant cases, the excess of lactic acid in the 
circulation may be so great as to overwhelm the nervous centres. An account 
is then given of the disease itself, which differs from other typhoid fevers chiefly 
in this, that an enormous amount of sour fluid is poured off from the skin, and 
that in many instances — not in all — a miliary eruption appears after a few 
days of these profuse sweats. It is important, however, to observe, that neither 
the fever nor the course of the disease is at all modified by this efflorescence. 
The distinction of two forms of the disease seems to Dr. Swaine simply con- 
venient, but not founded in any real difference except in degree. Mild cases 
of the disease often become suddenly and very unexpectedly malignant, and 
the patient dies comatose or convulsed, in spite of every variety of treatment. 
Other cases show this intensity from the first, and a few days, or even hours, 
decide them in a fatal sense. Post-mortem examinations throw no light upon 
these cases, beyond establishing plethora of the venous system, and a generally 
diffluent and black condition of the blood. In 1821, Rayer and others prac- 
tised the antiphlogistic treatment to its full extent. At the present day, 
immense doses of quinine are given, larger in proportion as the disease is 
intense. The proportion of deaths seems to be pretty equal under these two 
opposite poles of indication, and it is hard to suppress a smile at the zeal and 
confidence with which such different methods are advocated by their respective 
adherents. Of the statistics of the Herault epidemic little is as yet known. Dr. 
Swaine concluded his paper with a brief parallel between the suette miliaire of 
this and the last century, and the English sweating sickness of the Middle 
Ages. Dr. Swaine dissents from the opinion of Hecker, who regards the two 
diseases as essentially different, and himself considers that there is enough 
analogy between the two to justify us in classifying them together, admitting 
only that greater degree of intensity in the earlier disease, which might well be 
accounted for by the differential character of the two races, of their respective 
habits and customs, and especially by the different age of civilization under 
which the English sweating sickness occurred. 

31. A Comparative View of some of the more Important Points of the Pathology 
of Rheumatic and Non-Rheumatic Pericarditis, deduced from an Analysis of 
Cases. — Dr. Ormerod read an interesting paper on this subject before the Royal 
Medical and Chirurgical Society, November 9, 1852. He commenced by a refer- 
ence to the researches of the late Dr. Taylor, who had satisfactorily shown that 
acute rheumatism was not exclusively the cause of pericarditis, and who had 
also called attention to the importance of granular disease of the kidney in 
reference to this morbid condition. The author desired to limit the use of the 
word pericarditis to present inflammation of the pericardium ; and this analysis 
referred exclusively to cases of this nature. The means of investigation com- 
prehended complete records of 1410 cases observed under nearly similar cir- 
cumstances; that is, in the wards of different hospitals. Of these, 1249=88.59 
per cent, were not cases of rheumatism ; 161=11.41 per cent, were admitted on 
account of rheumatism, or suffered from it while under observation. Of the 
whole number, 85=6 per cent, had recent pericarditis, observed during life, or 
discovered after death, and were thus distributed: — 

24= 1.92 percent, occurred among 1249 non-rheumatic cases. 
61 = 37.88 per cent. " 161 rheumatic cases. 

85 = 6 per cent. 1410 
The mean age of 61 subjects of rheumatic pericarditis was about 21 ; the mean 



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[Jan. 



age of 24 subjects of non-rheumatic pericarditis was 42; the extremes being 7 
and 63 years. As to the different causes of the pericarditis: — 

Rheumatic, 61 cases coincided with acute rheumatism. 

-»t i c f 7 ensued on inflammation of lungs or pleura. 

Non-rheumatic, of »•» . -,. e^ v - j- 

i i n • • ' < 2 malignant disease of the pericardium. 

local ongin, ^ 1 « old cardiac disease> 

{6 coincided with granular disease of the kidney. 
4 " hemorrhage or exhaustion. 

2 " scarlatina or erysipelas respectively. 

2 were inexplicable. 

85 

The date of the accession of pericarditis was determined in 33 of the rheumatic 
cases. The mean of these observations gave the 10.5th day of the rheumatic 
attack as that on which the pericardial complication most commonly supervened. 
The question, whether a first or second attack of rheumatism was more likely 
to be accompanied by pericarditis, was beyond the reach of hospital statistics. 
This source of information was silent also on the question, whether pericarditis 
be more likely to occur in severe or in the slighter cases of rheumatic fever. 
It might, however, be safely inferred, that the severity of the articular and peri- 
cardial affections bore no very close relationship to each other. It was certain 
that the most severe, even fatal pericarditis, might occur where there was but 
faint evidence of articular affection, and this latter condition might exist in the 
most aggravated and intense form without involving the addition of pericarditis 
to the other sources of distress. The author then entered upon the considera- 
tion of the subject of non-rheumatic pericarditis of local origin; and a question 
of importance here presented itself: "What was the influence of pre-existent 
cardiac or pulmonary affections in inducing inflammation of the pericardium ? 
The question was of equal importance in relation to acute rheumatism. The 
relation of pulmonary inflammation to pericarditis was thus illustrated. In 
the 1410 cases, the basis of this inquiry, some form of pulmonary inflamma- 
tion — that is, pneumonia, pleuritis, or pleuro-pneumonia — was ascertained to 
exist, either by auscultation or dissection, in 265 cases. Of these, 

117 had pneumonia, of which 19 had recent pericarditis. 

86 had pleurisy, " 6 " 

62 had pleuro-pneumonia, " 8 " 

265 33 = 12.4 per cent. 

In the rheumatic class, pericardial inflammation commonly preceded, yet some- 
times, though rarely, followed pulmonary inflammation. The non-rheumatic 
class told quite a different story : here pulmonary inflammation had apparently 
a distinct influence in inducing pericarditis, and this influence was most evident 
in cases of pleurisy ; and clinical observation bore out the conclusion that the 
pericarditis was subsequent to, and probably contingent on the pulmonary in- 
flammation. The author then referred to the comparative fatality of non-rheu- 
matic compared with rheumatic pericarditis, and also to the desirableness of 
instituting an exact comparison between Bright's disease of the kidney and 
acute rheumatism, in respect to their tendencies to induce inflammation of the 
pericardium. In conclusion, the author desired to ascertain how far the results 
obtained by his present analysis agreed with those of the published cases of 
Dr. Taylor, who had made the subject of non-rheumatic pericarditis so pecu- 
liarly his own. The deductions seemed identical, and one rose from the perusal 
of those elaborate clinical reports with a conviction that non-rheumatic peri- 
carditis was more within the province of the anatomist than the physician. It 
was a disease with few or no symptoms, its physical signs were recognized more 
often by a chance discovery than on the suggestions of the disease, and its mor- 
bid changes small in amount and apparently inactive ; and, where opportunity 
had occurred of watching the disease some time previous to death, it had been 
apparently without effect on the general symptoms, its presence or absence being 



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Medical Pathology and Therapeutics, 



215 



determined by the ear alone; and still, in these, its connection with the fatal 
termination had appeared to be that of a coincidence rather than of a cause. 

Dr. Mayo concurred with the author in many of his views ; but thought that 
the statement of non-rheumatic pericarditis being on the whole unproductive 
of fatal results should be received with caution. Severe diseases, which ter- 
minated rapidly in death, were sometimes attended with such slight indications 
of their presence as altogether to escape observation. He remembered a case 
strikingly illustrative of this fact. A man was brought into the Marylebone 
Infirmary, having suffered an apoplectic seizure. Although the symptoms were 
not severe, in a short time he died. After death, both lungs were found in a 
state of gray consolidation, and presented evidences of severe and extensive 
pneumonia, which had given no indications of its existence during life. The 
morning previous to the fatal attack the man seemed to be only slightly unwell. 
A case had been related in the paper in which pericarditis attacked a maniacal 
patient ; and he thought it was an interesting question to consider how far the 
disturbance of the nervous system, in this and similar instances, disordered the 
nutrition of the part, and became a cause of pericardial inflammation. 

Dr. Fuller expressed his accordance with many of the opinions set forth in 
the paper. There were, however, certain points on which experience had led 
him to form conclusions different from Dr. Ormerod. It had been stated that, 
according to the author's observations, rheumatic pericarditis more frequently 
attended the second than the first attack of articular rheumatism. Now, the 
cases which had fallen under his own notice at St. George's Hospital led him to 
believe the reverse ; these cases seemed to indicate very strongly that pericar- 
ditis most frequently accompanied the first attack of articular rheumatism. He 
quite agreed with the author that acute articular disease was by no means sure 
to be associated with pericarditis, for he had often seen severe acute rheuma- 
tism without any pericardial complication, and he thought inflammation of the 
pericardium should be regarded as merely one of the symptoms of acute rheu- 
matism, as part of a general malady, which might or might not exhibit itself, 
and was not at all certain to do so in the most severe cases. With reference to 
the association of inflammations in important organs with pericarditis, out of 
27 cases treated by him, pneumonia showed itself in 18, and pleurisy or acute 
bronchitis in 21. He felt, at present, however, unable to declare in what de- 
gree the occurrence of such complications contributed to produce death. 

Dr. Heale could bear testimony to the extremely slight symptoms that some- 
times attended severe morbid conditions. He was summoned to an athletic, 
hearty-looking man, who had died with symptoms of tetanus. At the post 
mortem, one lung was consolidated throughout from the effects of pneumonia; 
the other was highly congested, and a strangulated inguinal hernia existed, 
including a portion of sphacelated intestine. He was unable to ascertain that 
any alarming symptoms had manifested themselves during life. 

Dr. Copland thought the author was entitled to the highest praise for hav- 
ing in his paper classified and grouped together the inflammations of various 
organs, regarding them not as simple manifestations, but as dependent on a 
general affection of the blood. A morbid condition of the blood diffusing itself 
throughout the system, exhibited itself at various points ; but in general one 
diseased action would predominate, and mask the others. Inflammation of 
serous surfaces was a concomitant of Bright' s disease, and such inflammation 
clearly arose from retention in the blood of certain deleterious principles, in 
consequence of the organ appointed for their elimination being unable to dis- 
charge its functions. It was of the utmost importance to look upon diseases 
not merely as local manifestations, but as the associated exhibitions of a morbid 
condition diffused throughout the system. — Med. Times and Gaz. Nov. 20, 1852. 

32. Recent Researches on Hematology. By MM. Becquerel and Bodier. — The 
following are the conclusions derived from recent researches: — 

1. In most chronic diseases, or rather as a result of various modifications in 
health, the three principal elements of the blood — globules, albumen, and fibrine, 
may be diminished or increased, singly or in combination. The associations 
depend on the nature of the diseases. 



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[Jan. 



2. The amount of globules is diminished in the course of most chronic dis- 
eases of long duration, especially in organic diseases of the heart, in chronic 
Bright' s disease, chlorosis, marsh cachexia, hemorrhages, excessive sanguineous 
discharges, fluxes, the last stage of tuberculization, and the cancerous diathesis: 
also, when the patient has had insufficient or innutritious food and insufficient 
air, damp and dark habitations, etc. 

3. The albumen of the serum diminishes in Bright' s disease, marsh cachexia, 
diseases of the heart in the third stage, extensive symptomatic anaemia, and 
the cancerous diathesis. The albumen is also diminished as a result of insuf- 
ficient food. 

4. The fibrine remains at its normal standard, and even rises above it, in 
acute scurvy ; it is diminished in chronic scurvy, and in the scorbutic state 
symptomatic of some chronic diseases ; and it is in diseases of the heart that 
this state is most frequent and best marked. 

5. In all the preceding cases the quantity of water in the blood is increased 
much above the healthy standard. 

6. The diminution in the amount of globules is shown chiefly by the follow- 
ing symptoms : loss of colour of the skin, palpitation, dyspnoea, blowing mur- 
mur with the first sound at the base of the heart, intermittent blowing murmur 
in the carotid arteries, continuous blowing murmur in the jugular veins. 

7. The diminution in the proportion of albumen, even when inconsiderable, 
when it takes place rapidly, quickly produces dropsy. When the diminution 
is more chronic, dropsy is still produced ; but the diminution of albumen must 
be greater than when it is acute. In general, dropsy is a symptomatic mark 
of the diminution of albumen. 

8. The diminution of fibrine is shown by the production of cutaneous or 
mucous hemorrhages. 

9. In the anemia symptomatic of excessive hemorrhage, of insufficient food, 
and of profuse fluxes, the change in the blood is characterized by low specific 
gravity, increase of water, diminution of globules, the albumen being of its 
normal quantity or sometimes slightly diminished, and the fibrine in healthy 
amount. 

10. In chlorosis, which is an affection quite distinct from anaemia, changes 
in the blood may be entirely wanting. When present, they consist in increase 
of the water, diminution of the globules, and the retention of the healthy quan- 
tity, or increase, of the albumen and fibrine, 

11. In acute Bright's disease, the quantity of globules and fibrine is normal, 
while the albumen is diminished. In chronic Bright's disease, the globules 
and albumen are diminished, and sometimes the fibrine. 

12. Most idiopathic dropsies are due to the diminution of albumen in the 
blood. They are acute or chronic, and generally have as their origin some 
destruction of the solid or liquid constituents of the organism. 

13. In diseases of the heart, the blood is changed in proportion as the fatal 
termination approaches. The changes consist in the simultaneous diminution 
of the globules, albumen, and fibrine, and in the increase of the water. 

14. In acute scurvy, the blood does not undergo any appreciable modification. 
In chronic scurvy, the fibrine is remarkably diminished in quantity, and some- 
times the globules are much increased. In both forms, an increase in the pro- 
portion of soda would explain the facts, but it wants demonstration. 

15. All these modifications exert a great influence on the medicinal treatment 
of various morbid conditions. Each element of the blood is modified by a spe- 
cial therapeutic method. The diminution in the quantity of globules is com- 
bated by chalybeates ; that of albumen, by cinchona and nutritious diet; the 
diminution of fibrine and the increase of soda in the blood, by tonic regimen 
and the use of vegetable acids. — Lond. Joum. Med. Oct. 1852, from Gazette 
Me'dicale de Far is, July 31, 1852. 

33. Microscopic Examination of a Relaxed Umda. — Dr. T. Inman records (Med. 
Times and Gaz. Sept. 4, 1852) the results of a microscopic examination of a 
portion of uvula excised from a gentleman who had had a severe cough for 
several weeks, which is interesting in a practical point of view. 



1853.] 



Medical Pathology and Therapeutics. 



217 



On examining the uvula, during the attempt at deglutition, the upper part was 
seen to contract firmly, leaving the lower part perfectly smooth and unchanged. 
It seemed thickened, but of natural colour. The lower portion was excised, 
and the following was the result of an examination of the fragment: — 

" It was very firm, almost fibrous in the interior, and covered with the ordi- 
nary mucous membrane, which was not hypertrophied. On making sections of 
the fibrous part, and tearing them up with needles, the structure was found to 
consist of groups of large cells, ^„ inch in diameter and studded with an im- 
mense number of granules. These were probably portions of enlarged and 
altered mucous glands, and were bound together by strong areolar tissue. 
Amongst these were interspersed numerous muscular fibres, arranged in bun- 
dles. They were 7 ^ inch in diameter, but had few of the ordinary characters 
of voluntary muscle. Very few were striated; all of them seemed to be com- 
posed of an outer membrane, and an inner substance closely resembling 
fibrine. It was homogeneous, yellow, divided irregularly into fragments by 
transverse divisions. All elasticity seemed to be gone. The majority of the 
fibres terminated in blunted points, as if they were undergoing absorption. 

" From this it will be seen that relaxation of the uvula is not (in every case at 
least) dependent upon muscular debility only, and therefore to be cured by local 
stimuli, but that it is sometimes occasioned by an actual change of structure 
preventing contraction. The part so diseased acts as a constant dead weight, 
and increases the mischief by dragging down that portion which is still healthy. 
In this case, no other remedy but excision could have been of any use. This 
simple corollary maybe deduced from the microscopic appearances, viz., when- 
ever the lower portion of the uvula is quite motionless during deglutition, it is 
useless to attempt to cure it, except by removal." 

34. Cirrhosis of the Liver. — An interesting discussion took place at the meet- 
ing of the Edinburgh Physiological Society (July 27, 1852) relative to this 
pathological condition. 

Dr. Bennett said he had examined numerous specimens of cirrhosis, of the 
hob-nailed, granular, and nutmeg livers, with the greatest care, and it appeared 
to him that the lesion partially consisted of an increase of the fibrous, and 
diminution of the cell, elements of the organ. Dr. Haldane seemed to be of 
opinion that the former depended on an exudation which was subsequently 
converted into fibres, but Dr. Bennett had never been able to trace those trans- 
formations which are observed in an exudation undergoing fibrous transform- 
ation. Hence, he was induced to think that the growth was more analogous to 
that form of increased nutrition described as hypertrophy — that is to say, slow 
and insensible increase of texture closely resembling the augmentation of bulk 
which occurs in the growing animal. He was aware that a membrane sur- 
rounding the lobules of the human liver had not yet been demonstrated to exist, 
but its presence was to be inferred by analogy ; and it was a question worthy 
of consideration, whether the increase of fibrous matter in cirrhosis did not con- 
stitute a proof of its being there. With regard to the diminution and atrophy 
of the cell elements in the liver, it might be asked, whether this was a primary 
lesion, or a secondary one, dependent upon the pressure and contraction of the 
surrounding fibres. It was very possible that both changes might occur to- 
gether, but he ascribed the principal influence to the increase of the fibrous 
element. He had been further led to believe that the nutmeg liver was only 
an incipient stage of cirrhosis, indicative of the increased vascularity which 
preceded and accompanied the commencing process of the fibrous hypertrophy. 
Dr. Bennett also described a lesion which closely resembled the nutmeg liver, 
and was commonly confounded with it, in which atrophy of the lobules pro- 
ceeded from without inwards, those cells in connection with the portal capil- 
laries having undergone fatty degeneration, while those in connection with the 
hepatic system were still normal. This lesion, he thought, might be a peculiar 
form of fatty degeneration of the liver. 

Dr. W. T. Gairdner said that he had examined, with great care, numerous 
instances of cirrhosis of the liver, and would state some of the results of his 
observations to the Society, although, in many respects, he considered the 



218 



Progress of the Medical Sciences. 



[Jan. 



pathology of the disease extremely obscure and unsatisfactory. In the first 
place, Dr. G. saw no good reason for assuming that a preliminary hypertrophy 
was an essential part of the pathology of cirrhosis. It was quite true that a 
hypertrophied liver might in certain cases be the starting-point of cirrhosis ; 
but in other instances the disease appeared to be unattended by increase of 
volume, even in its earliest stages. This fact was calculated to throw doubt 
upon the commonly received pathology, which ascribed the atrophy of cirrhosis 
to the contraction of a new fibrous tissue, the result of a subacute inflammatory 
exudation, or adhesive inflammation, as it was called by Dr. Budd. Without 
affirming positively the nature of the process concerned in the production of 
cirrhosis of the liver, Dr. G. considered that the essential anatomical condition 
of the disease was, undoubtedly, the atrophy of the glandular structure ; and 
that the hypertrophy, or apparent hypertrophy, of the fibrous element, was 
probably a result of the loss of due proportion between these two tissues. He 
had observed, in one instance, where the fibrous tissue around the granula- 
tions was in particularly large proportion, that it showed under the micro- 
scope an immense number of very peculiar nuclei, which were possibly the 
remains of the obliterated glandular cells. Dr. G. remarked that, according 
to his observations, there was no fixed relation between cirrhosis of the liver and 
any other primary form of disease of the organ. He had undoubtedly seen it 
apparently arising from the "nutmeg liver," as Dr. Bennett had observed; but 
not less frequently it was found apart from that condition and in connection 
with other morbid states, such as the pure fatty degeneration, or the waxy 
liver. In other cases, cirrhosis seemed to occur without any appreciable mor- 
bid condition of the remaining glandular tissue. As to the dependence of this 
lesion on obstruction of the biliary ducts or ultimate portal circulation, as 
asserted by Rokitansky, Dr. G. said he had not been able to come to a decided 
conclusion on this subject. The investigation was very difficult, from the fact 
that injection of the cirrhosed liver was generally unsuccessful, and the sepa- 
rate anatomical elements, or the limits of the acini, could rarely be made out 
in specimens, even of the incipient stage of this lesion. — Monthly Journ. Med. 
Sci. Nov. 1852. 

35. On the Proportion of the Subjects bitten by Mad Animals, who become 
affected with Hydrophobia. — M. Renault, Clinical Professor at the Veterinary 
School at Alfort, has recently presented to the Academy a valuable report, 
adverse to the claim again recently set up for the prophylactic power of mercu- 
rial inunction in hydrophobia. As this claim has been over and over again 
refuted, we should not have adverted to the subject, but for the valuable inci- 
dental matter introduced by the professor into his report. He observes, that 
before we can receive the numerous cases which have been published of the 
preservative power of mercurial salivation, it is necessary — 1. That it should 
be placed beyond all doubt that the animal inflicting the bite was really mad ; 
and that all the persons supposed to have been preserved have really been ex- 
posed to the infection. On examining the histories of these cases, however, 
such proof is quite defective, as in some of those related — e. g., by Ehrmann 
and Audry, the persons had not been bitten at all, but had merely lain or 
drank with those who had, or had wiped away their saliva. — 2. Next, when 
persons have been really bitten, and the animal has been really mad, we must 
be satisfied that the poison has been deposited in the wound. But numbers of 
the persons referred to have been bitten through their clothes, and every one 
knows how small a proportion of such acquire hydrophobia, even when no 
treatment at all has been employed. — 3. But even when the poison has been duly 
deposited in the wound, to admit the preservative power of the mercury, we 
must allow that all such persons would necessarily suffer from hydrophobia if 
left to themselves. Numbers of cases contradictory of this are, however, on 
record. But although all careful observers admit this, the proportion of such 
as escape has never been duly investigated; and the subject being one of the 
highest interest, M. Renault takes the opportunity of communicating the results 
of the investigations he has been conducting upon it at Alfort since 1828. 

To prevent confusion, he arranges the cases he has collected in two cate- 



1853.] 



Medical Pathology and Therapeutics. 



219 



gories. (A.) Cases of dogs or other animals accidentally bitten by others, 
either mad or supposed to be so, and sent by the police to Alfort, to remain 
under inspection. Of 224 dogs so brought, between 1827 and 1837, which con- 
tinued under observation for more than two months, without undergoing treat- 
ment, 74, or nearly one-third, became mad, and 130, or two-thirds, exhibited no 
symptoms. It is evident, however, that these cases do not afford any measure 
of the activity of the virus ; for the dog that caused the bite may not always 
have been mad, the bites could not always be verified, and the hair of the 
animal may have prevented the poison from penetrating. 

(B.) For this reason, another series of facts is adduced. From 1830 to the 
present time, certain dogs known as really mad have been made to bite, at the 
Clinical School, other dogs or herbivora in portions of the surface of delicate 
structure and devoid of hair, or inoculation has been performed with some of 
their saliva, collected during the height of the paroxysm. Of 99 dogs, horses, 
and sheep, so treated, 67 became mad, and 32 continued under observation 
more than one hundred days without any symptom exhibiting itself. Thus^ 
in this category, in which every circumstance favourable to infection was 
secured, no less than one-third of the animals escaped, without undergoing any 
treatment whatever. 

Examining the experience of other clinical professors, M. Renault says, that 
Professor Rey, of Lyons, has found that among animals who were accidentally 
bitten in the streets, and then placed under surveillance, 1 to 5 of the dogs, and 

1 to 4 of the horses, became mad. Of those bitten or inoculated experimentally, 

2 to 3 became mad. Of 16 animals accidentally bitten at Toulouse, 5 became 
mad. Professor Hertwig, of Berlin, states, that of 137 dogs accidentally bitten, 
16 only became mad, 121 remained uninjured; while of 25 experimentally in- 
fected, 10 became mad and 15 did not. Thus, in both the categories, the pro- 
portion affected was sensibly less in Berlin than in France, whether this be 
owing to climate or other cause. 

Thus, taking things at the worst, it results from these observations, made at 
different epochs, that two-thirds of the animals accidentally bitten, and one- 
third of those artificially infected, escape. 

Still, it must not be supposed that these mean residts of a great number of 
observations can be applied when speaking of the bite of a particular dog; for 
M. Renault has repeatedly observed, that while one dog, evidently mad, bites 
several others, and only one-sixth or one-seventh of these shall suffer, the virus 
combed from another dog, to all appearance in just the same condition, will 
infect nearly every animal (five-sixths or six-sevenths). 

Moreover, it is generally believed that the bites of mad wolves are oftener fol- 
lowed by hydrophobia than are those of dogs. Of 254 examples of such bites, 
the histories of which M. Renault has been able to collect in authors, in 164, 
or nearly two-thirds, hydrophobia followed — the proportion for accidental bites 
by mad dogs being only one-third. Whether this depends upon the fact that 
in the wolf the rabies is oftener spontaneous, or upon the more remarkable one 
that this animal almost always bites its victim in the face, neck, or head, is 
uncertain. — Brit, and For. Med.-Chirurg. Rev. Oct. 1852, from Bull, del' Acad. 
torn. xvii. 

36. Stomatitis Ulcerosa of Children. — Dr. F. W. Mackenzie, in an interesting 
article on this disease (Lond. Journ. of Med. Oct. 1852) says: — 

" These diseases are almost peculiar to the period of infancy and childhood; 
and, as far as I have observed, occur principally in children who have been 
badly fed, are exposed to atmospheric vicissitudes, reside in unhealthy locali- 
ties, or have been born of strumous or syphilitic parents. That it is essentially 
a constitutional affection, and not merely occasioned by bad air, endemic influ- 
ences, or unwholesome food, is, I think, certain; for I have known it to occur 
in robust-looking children, who had been living in healthy, open situations, 
and well supplied with good nourishment, and all the necessaries of life. In 
these cases, however, the disease was almost invariably found to have arisen 
from some local irritation, such as that of a carious tooth; and, when protracted, 
to be connected with some latent scrofulous taint ; whereas, in other cases, it 



220 



Progress of the Medical Sciences. 



[Jan. 



will arise in the absence of any local cause, and, apparently, from nothing else 
than a very deteriorated condition of the health. 

" In the general management of these cases, we are directed to employ, lo- 
cally, strong solutions of the nitrate of silver, or of the sulphate of copper or 
zinc, with or without astringent, stimulating, or detergent gargles, and to ad- 
minister, at the same time, quinine, tonics, and a liberal diet. I formerly fol- 
lowed these instructions closely, but sometimes with equivocal success; and I 
am now, after repeated trials, disposed to give the preference to the following 
method of treatment. It consists in removing, in the first place, any apparent 
cause of irritation, such as a decayed tooth, should it exist; and in applying, 
daily, the dilute nitric acid of the pharmacopoeia, to the whole of the ulcerated 
surfaces, by means of a sponge, or camel's-hair pencil; whilst, at the same 
time, the sesquicarbonate of ammonia is given in full doses, combined with the 
citrate of iron. "When the tongue is coated, and the alvine discharges are un- 
healthy, it is necessary to premise an emetic of ipecacuanha and squills, as 
well as a purgative of calomel and rhubarb. It is also necessary that the pa- 
tient should be well supported by a nutritious diet, and an adequate allowance 
of malt liquor, or wine. 

" I will briefly add, that the employment of ammonia in these cases was first 
suggested to me from observing its beneficial effects in the ulcerative affections 
of the mouth and throat, which occur in children in connection with scarlet 
fever. And, alone, it will accomplish a cure, as some of the following cases show, 
although less speedily than when combined with the citrate of iron and the 
local application of dilute, nitric acid. The latter remedy appears to have a 
remarkable influence in improving the character of the ulceration and arrest- 
ing its progress. The sloughy, dirty, yellowish appearance, which it generally 
presents, is soon changed for a florid, healthy, granulating surface; and this 
result would appear to depend upon the moderately-stimulating properties of 
the remedy, which are not disproportionate to the exhausted vital powers of the 
part." 

37. Removal of the Obstructing Mucus in the Suffocative Bronchitis of Infants. 
— In an instructive case which he relates, M. Valleix draws attention to the 
importance of mechanically clearing away the mucus from the throats of infants, 
in the suffocative paroxysms observed in the generalized bronchitis so fatal to 
young children. As soon as the child assumes a violaceous appearance, and 
suffocation seems imminent, the little finger should be passed along the back 
of the tongue. The child, closing its jaws, resists strongly, but the finger 
should be gradually advanced. When it reaches the isthmus, the child opens 
its mouth, and we should then pass on behind the epiglottis, so as to bring the 
pulp of the finger several times over the orifice of the larynx. This produces 
efforts at coughing and vomiting, and the mucus is expelled from the air-pas- 
sages, a part being drawn out with the finger, and the rest swallowed. The 
child appears, after this little operation, much flushed and agitated, and almost 
suffocated ; but it soon becomes calm, until renewed signs of asphyxia call for 
a repetition of the procedure. In the case which M. Valleix relates, apparent 
death, after one of these paroxysms, was sucessfully treated by artificial respi- 
ration, the employment of which he strongly recommends in similar cases. — 
Brit, and For. Med.-Chirurg. Review, Oct. 1852; from li 'Union Medicate, No. 48. 

38. Treatment of Amenorrhosa. By H. Bennett, M.D. — "When the advent of 
the menstrual flux is retarded in well-developed young females, who evidently 
suffer, both generally and locally, from the delay, a little judicious manage- 
ment will often determine its appearance. The state of the health should first 
be carefully scrutinized, and any general or functional derangement remedied 
by proper treatment. If the patient is weak and delicate, the various prepara- 
tions of iron, with a generous dietary, are often of great use. If, on the con- 
trary, she is plethoric, and subject to headache and flushing of the face, a light 
diet, gentle exercise, and alterative or saline medicines are indicated. A young 
female suffering in this way is better at home, under the eye of a devoted and 
attentive mother, should she be fortunate enough to possess such a parent, than 



1853.] 



Medical Pailiology and Therapeutics. 



221 



in a public school, where the rigid discipline usually enforced renders it difficult 
to pay that attention to her state which it requires. Under the influence of these 
general means, the menstrual function usually manifests itself, and becomes 
regularized in the course of a few months. Should they prove inefficient, slight 
periodical stimulation of the uterine system should be resorted to. The plan I 
most frequently adopt is, the application of large mustard poultices to the 
breasts and inner and upper parts of the thighs, alternately, night and morn- 
ing, during five or six days, every four weeks. The mustard poultices should 
be allowed to remain on until the skin reddens and begins to feel painful, but 
not long enough to blister it, as that would prevent their being replaced the 
following day. The feet may also be put in hot water night and morning, for 
a few minutes, and if there is any pain in the hypogastric or ovarian regions, 
large warm linseed poultices, sprinkled over with laudanum, may not only 
afford relief, but also promote the menstrual excretion. When the symptoms 
of local congestion are very marked, the application to the vulva of a few 
leeches every month, or about the fifth day of the local treatment, may be of 
great assistance. The commencement of this local treatment should be made 
to coincide with the menstrual nisus, when it manifests itself periodically. 
When it does not, a certain date should be taken, and adhered to at the inter- 
val stated — that is, every twenty-eight days. In such cases, the medicines 
known as emmenagogues, which exercise a special influence over the uterus, 
are scarcely, in my opinion, admissible, the object being to gently promote the 
natural function, and not to violently stimulate, and probably irritate, the 
uterine organs. 

"In amenorrhcea connected with deficient uterine and bodily development, 
the local treatment should be conducted on the same principles, only it gene- 
rally requires to be carried out more perseveringly, and for a greater length of 
time. In addition to the means mentioned, I have also derived great benefit 
from electricity, the electric current being carried through the pelvis from the 
hypogastric to the sacro-lumbar region, for an hour night and morning, during 
the week that local means are resorted to. In these cases, it is evident that 
the non-development of the body is often in a great measure the result of the 
dormant condition of the uterine organs, inasmuch as I have repeatedly suc- 
ceeded in rousing them to action by the local treatment above detailed, when 
the most judicious and persevering general treatment had failed. In these 
cases, I have invariably seen the bodily structures subsequently develop them- 
selves with great rapidity. At the same time, the knowledge of this fact 
must not for a moment prevent our employing every possible means of invigo- 
rating the general health, of vitalizing the economy, and of promoting the 
regular play of the various functions. After removing any morbid functional 
condition which a careful scrutiny may detect, recourse should be had to the 
mineral and vegetable tonics, and especially to ferruginous preparations, to 
which should be added a generous diet, moderate foot or horseback exercise, 
cold bathing or sponging, early hours for retiring and rising, and residence in 
the country, if possible. 

"When amenorrhcea can be traced to a debilitating disease, such as chlo- 
rosis, phthisis, scrofula, etc., the best treatment is the treatment of the disease 
to which it is referrible. Thus, in chlorosis, the menstrual flux gradually 
diminishes, and may finally cease altogether under the influence of the progres- 
sive deterioration of the blood, without there being any uterine disease or any 
other uterine symptom than the scantiness and final disappearance of the secre- 
tion. As under appropriate general treatment the blood becomes healthy, 
menstruation returns or again becomes gradually more and more normal, with- 
out any local treatment being necessary in the immense majority of cases. 
The same may be said of scrofulous and other forms of constitutional debility. 
In pulmonary phthisis, the falling off and final disappearance of menstruation 
is a symptom of much more serious import, as it is generally connected with 
the more advanced stages of the disease, and with an amount of tubercular 
deposit, and of consequent marasmus, through defective nutrition, which ren- 
ders the chance of a recovery very problematical. 

"Amenorrhcea from physical obstacles can only be remedied by surgical 
No. XLIX.— Jan. 1853. 15 



222 



Progress of the Medical Sciences. 



[Jan. 



means. If the hymen is imperforate, or the lips of the vulva are adherent, 
and the menses have collected behind, a crucial incision in the centre of the 
bulging hymen, or vulvar protuberance, is all that is required. Care, however, 
should be taken, once the menstrual fluid has been evacuated, that the divided 
surfaces do not unite and cicatrize. This is to be prevented by the use of small 
sponge or cotton tents for a few days, or by the application of the nitrate of 
silver to the edges of the incisions — a more painful but equally efficacious pro- 
cess. When the vagina is partially or wholly absent or closed, either congeni- 
tally or by adhesion from accidental causes, the case is a much more serious 
one, and more difficult to remedy. If there is merely adhesion of the walls of 
the vagina, this adhesion can generally be removed by the dilatation of the 
vagina, coupled with the gradual and careful division of the adherent surfaces. 
When the vagina is partially or entirely absent, the symptoms produced by the 
retention and accumulation of the menses in the uterus may be sufficiently 
serious to render it imperative to attempt to form an artificial passage, by sur- 
gical means, to the distended uterus. In such cases, the difficulty and risk of 
the operation depend on the distance that separates the vaginal cul-de-sac or 
the imperforate vulva from the uterus, the operator having to make his way 
between the rectum and the bladder. Considerable assistance in diagnosis is 
derived from a careful rectal examination. It is of great importance to find a 
vent for these uterine accumulations of menstrual fluid, as, in addition to the 
suffering endured, there is positive danger to life. Cases are on record in which 
the distension of the uterus extended to the Fallopian tubes, and in which death 
occurred from the peritonitis occasioned by their rupture. 

"Occlusion of the os uteri, as a congenital occurrence, is rare; but since I 
first recommended the use of potassa cum calce as a last resource in obstinate 
inflammatory disease of the cervical canal, I have seen several cases in which 
its use had been followed by all but complete occlusion, and by partial reten- 
tion of the menses, or at least their difficult excretion. This was evidently 
owing to the want of due caution at the time of application and during the 
period of healing afterwards. The tendency of the tissues thus treated to con- 
tract being very great, it should be counteracted, if necessary, by the occa- 
sional use of wax bougies, until the process of repair has been fully accom- 
plished. The possibility of this accident occurring through the want of caution 
of the operator, does not in the least invalidate the utility of the remedy, as an 
exceptional and ultimate one. I have generally, but not always, found this • 
form of occlusion easy to remove by progressive dilatation. Should occlusion 
of the os uteri exist congenitally, once recognized it is easily remedied by a 
slight incision in the region of the os, and by subsequent dilatation. 

" The catamenial function appears to be more especially liable to arrest from 
accidental temporary influences, in those females who present the low degree 
of sexual vitality to which allusion has been made in the first part of this 
paper, and with whom menstruation appears late and with difficulty. In such 
constitutions, indeed, it sometimes stops for many months, or even perma- 
nently, if no treatment be resorted to, without any apparent cause. Under the 
influence of decided general and local treatment, the menses will often return 
for a time, but flag and cease as soon as the treatment is suspended. If there 
is no positive disease of the uterus or ovaries, the emmenagogues, such as ergot 
of rye, savine, etc., may be cautiously tried. I have known also the married 
state, especially if followed by conception, produce a complete change in the 
functional activity of the uterine system, and menstruation become regular and 
natural. It is in these cases that the application of the nitrate of silver to the 
cavity of the uterus, or the scarification of its mucous surfaces, has been pro- 
posed. I must confess, however, that I do not think we are warranted in thus 
interfering with so delicate and sensitive a region of the uterus for such a pur- 
pose. In the unmarried female, the application of leeches to the vulva, and in 
the married to the neck of the uterus, answers every purpose, without being 
open to the same objection. 

" The development of inflammatory disease in the neck or body of the ute- 
rus, or in the ovaries, and of cystic and scrofulous tumours in the ovaries, is 
one of the most frequent causes of amenorrhcea in those in whom the function 



1853.] 



Surgery. 



223 



has once been fairly established, and especially of partial amenorrhoea. "When 
such lesions exist, they generally give rise to other symptoms which an atten- 
tive and well- informed observer may easily recognize. This remark, however, 
applies more to the uterus than to the ovaries, for important morbid changes 
are not unfrequently found after death in the latter organs, which, during life, 
have given little other evidence of their existence than the modification or 
arrest of the catamenial functions. 

" In all these cases, the amenorrhoea is merely a symptom of the ovarian or 
uterine disease. The latter is the condition to be treated, the only indication 
the amenorrhoea itself supplies being the advisability of having recourse to 
such local means as are calculated to promote menstruation, whenever nature 
appears to be making the least effort to establish the menstrual flux. 

" In vicarious menstruation, our first effort ought to be directed to the resto- 
ration of the integrity of the uterine organs, if it be impaired. We should then, 
by all the means enumerated, attempt to divert the molimen hjemorrhagicum 
of menstruation from its abnormal to its normal seat. The most important of 
these means is the abstraction of blood from the vulva or cervix uteri, which 
should be resorted to every month, a day or two before the vicarious menstrua- 
tion is expected, and may be repeated after it has begun, should the strength 
of the patient admit of such a step. By this treatment, the menstrual nisus 
may nearly always be diverted into its natural channel; whereas, any attempt 
to stop the morbid hemorrhage, by means applied directly to the organ from 
which it takes place, might be productive of mischief to the system at large." 
— Lancet, April, 1852. 

39. A New Method of Auscidting the Eustachian Tube. By Professor Richter. 
(Schmidt's Year-Book, 1851, No. 4. Journ. Pratt. Med. Prague, 1852, vol. ii.) — 
Professor Richter states that the method here detailed supplies the place of 
Harvey's auriscope, as well as renders the use of the catheter as a means 
of diagnosis unnecessary, thus avoiding the introduction of an instrument into 
the Eustachian tube, the use of which is both difficult and dangerous. The 
external cartilage of the ear is bent forwards and pressed flat upon the external 
orifice of the ear, closing it tightly. A stethoscope, having the expanded or 
funnel end of small size, is placed upon the cartilage, bent over the ear as 
described above, making sufficient pressure to keep the cartilage flat upon the 
skull, and the external orifice of the ear entirely closed. When the Eusta- 
chian tube is free, the passage of the breath through the mouth and throat is 
distinctly heard, as well as the sound made in speaking, whistling, or hawk- 
ing. The most striking effects are observed when one is enabled to produce 
consonance in the Eustachian tube. For the above purpose, the patient is re- 
quested to sing, or, better still, to whistle the notes of the musical scale, if pos- 
sible, the entire extent. In certain tunes the listener, as well as the patient, 
will hear distinctly the consonance or accord in the ear which is closed; and 
even at times accompanied by a metallic echo, produced in the stethoscope. 
(The editor observes that the notes G, F, E, in the small and large octave with 
A's and E's, will be heard in whistling, and G and A in singing.) Should the 
Eustachian tube be closed, all of these effects above enumerated will be entirely 
wanting. 



SURGICAL PATHOLOGY AND THERAPEUTICS, AND OPERATIVE 

SURGERY. 

40. Hospital Gangrene. — G. J. Guthrie, Esq., one of the most experienced 
military surgeons of the day, in a recent lecture on this subject, gives the fol- 
lowing conclusions as the result of his vast experience : — 

1. Hospital gangrene never occurs in isolated cases of wounds. 

2. It originates only in badly-ventilated hospitals, crowded with wounded 
men, among and around whom cleanliness has not been too well observed. 



224 



Progress of the Medical Sciences. 



[Jan. 



3. It is a morbid poison, remarkably contagious, and is infectious through 
the medium of the atmosphere applied to the wound or ulcer. 

4. It is possibly infectious, acting constitutionally, and producing great 
derangement of the system at large, although it has not been satisfactorily 
proved that the constitutional affection is capable of giving rise to local disease, 
such as an ulcer ; but if an ulcer should occur from accidental or constitutional 
causes, it is always influenced by it when in its concentrated form. 

5. The application of the contagious matter gives rise to a similar local dis- 
ease, resembling and capable of propagating itself, and is generally followed 
by constitutional symptoms. 

6. In crowded hospitals the constitutional symptoms have been sometimes 
observed to precede, and frequently to accompany, the appearance of the local 
disease. 

7. The local disease attacks the cellular membrane principally, and is readily 
propagated along it, laying bare the muscular, arterial, nervous, and other 
structures, which soon yield to its destructive properties. 

8. The sloughing of the arteries is rarely attended by healthy inflammation, 
filling up their canals by fibrine, or by that gangrenous inflammation which 
attends on mortification from ordinary causes, and alike obliterates their cavi- 
ties. The separation of the dead parts is, therefore, accompanied by hemor- 
rhage, which, when from large arteries, is usually fatal. 

9. The operation of placing a ligature on the artery at a distance, or near 
the seat of mischief, does not succeed, from the incision being soon attacked 
with the disease, unless it has been arrested in the individual part first affected, 
and the patient has been separated from all others suffering from it. 

10. The local disease is to be arrested by the application of the actual or 
potential cautery: an iron heated redhot, or the mineral acids pure, or a 
solution of arsenic, or of the chloride of zinc, or some other caustic which shall 
penetrate the sloughing parts, and destroy a thin layer of the unaffected part 
beneath them. If a sinus or sinuses have formed under the skin or between 
the muscles, from the extension of disease in the cellular or areolar structure, 
they must be laid open, and the cautery applied; for if any part affected be left 
untouched or undestroyed by the acid, the disease will recommence and spread 
from that point. The parts touched by the acids or cautery may be defended 
by cloths or other material, wetted with hot or cold water according to the 
feelings of the sufferers, and poultices of various kinds may be had recourse to, 
if unavoidable. 

11. After the diseased parts have been destroyed by the actual or potential 
cautery, they cease in a great measure to be contagious, and there is less 
chance of the disease being propagated to persons having open wounds or 
ulcerated surfaces. A number of wounded thus treated are less likely to dis- 
seminate the disease than one person on whom constitutional treatment alone 
has been tried. 

12. The pain and constitutional symptoms occasioned by the disease, con- 
sidered as distinct from the symptoms which may be dependent on disease 
endemic in the country, are all relieved, and sometimes entirely removed, by 
the destruction of the diseased surface ; which must, however, be carefully and 
accurately followed to whatever distance, and into whatever parts it may extend, 
if the salutary effect of the remedies is to be obtained. 

13. On the separation of the sloughs, the ulcerated surfaces are to be treated 
according to the ordinary principles of surgery. They cease to eliminate the 
contagious principle, and do not require a specific treatment. 

14. The constitutional or febrile symptoms, whenever, or at whatever time 
they occur, are to be treated according to the nature of the fever they are 
supposed to represent, and especially by emetics, purgatives, and the early 
abstraction of blood if the fever be purely inflammatory, and by less vigorous 
means if the fever prevailing in the country be of a different character. Pain 
should be alleviated by opium, which should be freely administered. 

15. The essential preventive measures are separation, cleanliness, and expo- 
sure to the open air — the first steps towards that cure which cauterization will 
afterwards in general accomplish. 



1853.] 



Surgery. 



225 



16. If the sufferer be very young, or of a weakly habit, his strength will fre- 
quently require to be supported in the most efficient manner by a due adminis- 
tration of the cinchona bark, wine, and a generous diet ; means often found 
essentially necessary after all severe attacks of debilitating diseases. 

The formidable nature of this terrible disease, before the local application of 
caustic remedies was fully adopted, will be best understood by the following 
document : — 



Return of the Number of Cases of Hospital Gangrene which have appeared at the 
Hospital Stations in the Peninsula between the 21st June and 1\th December, 
1813. 



Stations. 


Xo. of cases 
occurred. 


Discharged 
cured. 


Died. 


Under 
treatment. 


No. ope- 
rated upon. 




Santander 
Bilbao 


160 
972 


72 
557 


35 
387 


53 
28 


25 
183 


Most of these cases were 
sent from Vittoria. 


Vittoria 
Passages 

Vera 


441 
41 


349 
2 


88 
2 


4 


74 


Thirty-seven transferred 
to Santander. Vera, be- 
ing almost on the field of 
battle, had no case. 




1614 


980 


512 


85 


282 





Lancet, Sept. 1852. 



41. On the Cure of Ncevus and Erectile Tumours by Elastic Subcutaneous 
Strangulation and Section. — Dr. Startin, in a paper read before the Royal Me- 
dical and Chirurgical Society, November 9, 1852, described a new method of 
treating mevus and erectile tumours, which consists in encircling the tumour 
with a ligature passed beneath the skin by means of a long, angular-pointed 
needle, so as to include the morbid parts in a triangular space, extending a line 
or so beyond the boundaries of the nsevus. To one angle of this subcutaneous 
thread elastic tension is applied by means of a vulcanized India-rubber ring or 
band, which occasions it to ulcerate or cut its way through the vascular struc- 
ture constituting the malady, and thus obliterate its vessels and cure the com- 
plaint. The author describes two methods of operating by elastic strangula- 
tion. The first is to fix the tension upon the subcutaneous thread half an inch 
from its exit at the most convenient angle for applying it, without previously 
tying a knot upon the tumour, as in the case of the ordinary subcutaneous 
ligature. The second method is to employ a subcutaneous ligature, and tie a 
knot upon it, so as to strangulate or arrest the circulation in the tumour before 
applying the tension. In most cases of extensive ngevus both methods are re- 
quired; the first, where the complaint is superficial, or implicates some of the 
features, as the eyelids or nose, for example ; the second, where the malady is 
deeper, and may be regarded rather in the light of an erectile tumour, contain- 
ing large bloodvessels, the too sudden division of which might be productive of 
troublesome hemorrhage. The author illustrated his paper by a wax-model cast 
from a nsevus, which had been under treatment ; and he brought forward a case 
of instruments which contained one or two original contrivances to facilitate 
the operation he described. The cases where "elastic strangulation and sec- 
tion" were deemed most applicable were examples of the malady involving 
various parts of the face or hairy scalp, where the cure by extirpation with the 
knife, by caustics, by breaking up the nsevus in various manners, or by the 
ordinary subcutaneous ligature, would either produce too great disfigurement, 
risk of hemorrhage, loss of skin, or distortion of the features, to be advanta- 
geously resorted to. Several cases were cited in illustration of the plan advo- 
cated, and the success attending it, in one of which as many as thirty operations 
had been previously tried, by various surgeons, without a satisfactory result. 
For the details of these cases, as also for a more complete account of the opera- 



226 



Progress of the Medical Sciences. 



[Jan. 



tion, reference must be made to the paper itself. The author incidentally 
remarked that this operation, as far as the employment of elastic tension is 
concerned, appeared to him to he capable of adaptation to several other depart- 
ments of surgery where such a force might be required, or where a ligature is 
used. As examples, he instanced the retained ligatures of arteries in healing 
wounds, or after tying uterine polypi, deep portions of tumours, hemorrhoids, 
varicose veins, as also in the extraction of the guinea-worm, the maintaining 
in position some fractures and dislocations ; but, as these considerations were 
foreign to the subject under notice, he concluded by stating that, since the writ- 
ing of his paper six months ago, he had successfully employed elastic strangu- 
lation and section in four cases of nrevus ; and that he was authorized by Mr. 
Paget, of St. Bartholomew's, to mention that he had twice adopted the plan 
with a fortunate result, although in one instance sloughing of the skin super- 
vened, an occurrence which never happened in the author's own practice. — 
Med. Times and Gaz. Nov. 20, 1852. 

42. Result of the Ligature of the large Arteries in eighty-two cases occurring in 
the Practice of M. Roux. — The following eighty-two operations comprise the 
whole number of ligatures of arteries performed by M, Roux, since 1808, and 
were communicated by him to the Soeiete de Chirurgie. An abstract of the 
paper has been published in IS Union Medicate: — 



Arteries. 
Popliteal artery 



Femoral artery 46 



Brachial artery 20 



Operations. 

1 Spontaneous Aneurism (ancient operation). 
3 Recent wounds. 

2 For hemorrhage after gunshot wounds. 
2 Wounds of artery in operation. 

7 Hemorrhage after amputation. 

1 Femoral aneurism (Hunter's operation). 

2 Femoral aneurism (ancient operation). 
2 Fungous tumour of tibia. 

27 Popliteal aneurism (Hunter's operation). 
10 False aneurism of the bend of the arm. 

6 Arterio-venous aneurism. 

2 Hemorrhage after amputation. 

1 Spontaneous aneurism of the ulnar artery. 

1 Fungous tumour of the radius. 

1 Fungous tumour of the orbit. 

2 "Wound of the face. 

3 As a precautionary measure before operations. 
1 Spontaneous aneurism. 

1 Recent wound with false aneurism. 

2 Hemorrhage after amputation at the shoulder-joint. 
Secondary hemorrhage. 

Secondary hemorrhage after ligature of the femoral 
artery. 



Carotid (common) 

Axillary (immedi-] 

ately below the f 

clavicle) j [ 

Subclavian 3 

External Iliac 2 
Total 82 

In these operations the distal mode of Brasdor has not been tried. The old 
method 16 times ; and that of Hunter, with Scarpa's ligature, 66 times. The 
number of cases of true aneurism was 33, of which two only were women. The 
results were, 10 unsuccessful and 23 cures. The number of false aneurisms 
was 10, all of which were successfully treated. 

Of the six cases of arterio-venous aneurism, for which the humeral artery was 
tied in each case, four were successful, and in two amputation was necessitated 
by gangrene or secondary hemorrhage. 

These statistical facts will be read with interest by the English surgeon, by 
whom the thick ligature used by Scarpa is now carefully eschewed, but the 
small number of cases (4) in which secondary hemorrhage occurred, will cer- 



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227 



tainlybear out M. Roux in his attachment to this mode of operation. The dif- 
ference between the English and French modes of conducting the ligature of 
arteries is so great, both in the operation itself and in the dressing of the wound, 
that we rejoice to find that the above facts will form part of a complete work on 
surgery, which M. Roux is now preparing, and of which the memoir presented 
to the Societe de Chirurgie is only an instalment. — Prov. Med. and Surg. Journ. 
Oct. 27, 1852. 

43. Compression in Aneurism. — It is stated in the Lancet (October 9, 1852), 
that, within the last year, cases of aneurism have been submitted to compres- 
sion in several of the London hospitals with satisfactory results. 

The following case, treated in the London Hospital by Mr. Critchett, affords 
a good example of the rapid manner in which well applied and carefully di- 
rected compression may promote the solidification of an arterial tumour, for all 
pulsation had ceased on the eighth day ; and this case may be cited as the first 
among those which have been treated in the hospitals of London, wherein a 
week's compression sufficed to obtain the cure of the disease. 

A hawker, aged thirty-two years, in the habit of gaining his living by selling 
salt about the streets, was admitted into the London Hospital, under the care 
of Mr. Critchett, in the middle of May, 1852. The patient had recently suf- 
fered from a severe attack of laryngitis, but was gradually recovering, having 
been under medical treatment for the affection prior to his coming into the 
hospital. 

A large aneurism occupied the lower and inner part of the left thigh, and 
extended somewhat forwards and backwards, internally, to the median line of 
the limb. The lowermost part was on a level with the upper border of the 
patella, and the highest extended to about the inferior part of the middle third 
of the thigh. The sac altogether gave the idea of being about the size of a small 
shaddock ; the cyst felt thin, and the thinnest part was in front and internally, 
in which situation the integuments were dark, as though from a slight amount 
of subcutaneous ecchymosis. Pulsation was everywhere distinct, and a bruit 
de souffiet, though not very loud, was audible, being, however, more distinct 
over the track of the popliteal artery than elsewhere. Both these conditions 
ceased on pressure being made on the femoral artery, the tumour, at the same 
time, somewhat diminishing. 

The compression treatment was systematically commenced on the seventh 
day after the admission of the patient. Before the apparatus, Signorini's 
tourniquet, was had recourse to, the nature of the treatment and the mode 
of carrying it out were explained to the patient. The sheets, mattress, and 
pillows on which he lay were firmly fixed to the bed-frame, and the square 
pad on which the left limb, in a state of partial eversion and flexion, was placed, 
was also firmly attached ; and at the bottom of the bed a large pillow was se- 
cured by bandages, and served as a, point d'appui for the right foot, so that any 
gliding of the body could be avoided. A large cradle was placed over the body, 
in order that the bedclothes should not interfere with the proper action of the 
instruments. One drachm of acetate of potash was ordered to be taken three 
times a day ; the patient was placed on middle diet, without beer, and was re- 
quested to drink as little as possible. The hair was shaved from off the skin 
over the pubis and the middle of the thigh, and the integument dusted over 
with flour. 

A variable and occasionally interrupted pressure was maintained on the 
femoral artery for eight days, through the medium of a four-pound meat-weight 
(acting on a common tourniquet pad) to the groin; and a clamp at the thigh, 
applied at two distinct parts — the one two inches above the upper boundary of 
the aneurism, the other a little higher. The weight at the groin and the clamp 
were alternately used. The former instrument was kept on sometimes for an 
hour, at others for only half an hour ; and prior to its being removed, the clamp 
was usually adjusted, and kept on for a period ranging from five to fifteen 
minutes. 

During these eight days, the patient slept four or five hours each night, the 
pressure being of course not so uniformly kept up as during the day, but the 



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same method being followed out as far as possible. On the fourth day after the 
first application of the instruments, a small superficial vessel could be detected 
pulsating along the inner border of the patella; on the fifth and sixth, the pa-, 
tient had a sensation of pins and needles over the upper part of the tumour, 
which latter had become much harder, less in size, and sensibly hotter than the 
surrounding parts. The pulsation, on the sixth day, was just perceptible ; and 
on auscultation, only an impulse, like the first sound of the heart, but much 
more feeble, was detected. 

On the seventh day, the hair was again removed from the groin and middle 
of the thigh ; and on the eighth, the pulsation in the aneurism had entirely 
ceased. 

Between the fifth and eighth day, four or five small vessels were detected 
pulsating in the vicinity of the patella. On the ninth day after the aneurism 
was cured, a small superficial vessel was observed running over its centre. The 
pressure was continued for a week after all pulsation in the tumour had ceased; 
and the patient became an out-patient in the beginning of July, having been 
in the hospital fifty-two days. There was a good deal of oedema about the leg 
when he went out, but this gradually subsided after careful bandaging. 

44. Cases of Popliteal Aneurism cured by Pressure. — Dr. W. K. Swettenham, 
Surgeon to 44th regiment, reports (Lancet, Sept. 4, 1852) a case of popliteal 
aneurism in a healthy, able-bodied seaman, thirty-two years of age, success- 
fully treated by pressure. The instruments employed were those invented by 
Mr. Reed, of Dublin. The tumour was perfectly solid six days after the first 
application of pressure to the main arterial trunk. 

Mr. Prescott Hewett treated (Lancet, Oct. 9, 1852), by compression, a 
short time ago, at St. George's Hospital, a case of popliteal aneurism ; the 
solidification of the sac was rather a long time in being effected, and it is not 
unlikely that the delay was partially owing to circumstances hardly under the 
surgeon's control. It would appear that the patient, a woman about thirty 
years of age, was admitted January 17, 1852, with popliteal aneurism on the 
right side. Much care was bestowed on the exact adjustment of the instru- 
ment, which consisted of the usual steel hoop, with a screw and pad acting ver- 
tically in a ball and socket. Pain and discomfort, though a weight was used 
at the groin, prevented, at one time, the compression from being carried on ; 
it was, however, subsequently persevered in for several months, Mr. Hewett 
placing the patient, towards the end, on very low diet. At the expiration of 
about five months, the tumour ceased to beat, and gradually became hard. 
There was reason to suppose that the horizontal posture was not so strictly 
continued as might have been desirable. 

45. On a New Mode of Operating in Varicose Aneurism. By M. Malgaigne. 
— The difficulty which usually occurs in operating for this, in securing the two 
ends of the artery, while the veins are incessantly pouring out blood, induced 
M. Malgaigne to try a new plan of procedure, by which opening the sac, or the 
integuments covering it, might be avoided. The case was an aneurism result- 
ing from venesection, performed ten or twelve weeks before. A small pulsa- 
tory tumour existed at the bend of the arm, which caused little inconvenience. 
The artery was taken up, by means of two separate incisions, just below and 
just above the tumour, and the cure was rapid and complete, so that when the 
patient was seen seven months afterwards, no traces of the aneurism could 
be observed. — Brit, and For. Med.-Chirurg. Rev. Oct. 1852, from Rev. Med. 
Chirurg. torn. xi. 

46. Ligature of the Vertebral Artery in a Case of Gunshot Wound. — M. Mai- 
sonneuve relates a case, which, although it terminated fatally, is of interest on 
account of the course which the ball took, and the successful ligature of the ver- 
tebral artery. A lady was shot in the neck, and the ball glanced downwards 
from the side of the cricoid cartilage, and penetrated between the trachea and 
oesophagus, the great bloodvessels, and nerves, without injuring any of them, 
until it reached the sixth cervical vertebra, deep into the body of which it be- 



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229 



came impacted. In its course it fractured the left transverse process, and divided 
the vertebral artery. The hemorrhage which occurred at the time of the acci- 
dent soon stopped, but recurring again violently on the eighth and ninth days, 
the wound was enlarged in order to search for the vessel. On removing the 
finger from the hole in the vertebra, whence the ball was extracted, the ends 
of the bleeding vessel were perceived and secured ; this, from the ease with 
which the operation was performed, being at the time supposed to be the infe- 
rior thyroid. The ligatures came away in ten days, and all seemed doing well, 
when the patient, at the end of the third week after the accident, suddenly fell 
into a state of coma, and soon expired. The two ends of the vertebral artery 
were found firmly plugged with coagula, but necrosis had affected the verte- 
bra, and an aperture led to a communication with the spinal canal, where 
there was sero-purulent effusion. — Brit, and For. Med.-Chirurg. Rev. Oct. 1852, 
from-i7 Union Me'dicale, No. 34. 

47. Microscopic Examination of Cancer. — Dr. Murchison read to the Edin- 
burgh Physiological Society, May 23, 1852, the particulars of a case of cancer- 
ous disease of the uterus and adjacent organs, and likewise of the liver, in 
which cerebral symptoms became prominent before death. On post-mortem 
examination, there was found, besides unequivocally cancerous masses in the 
above situations, a lesion of the brain, resembling to the naked eye some forms 
of cerebral softening; but on closer examination, especially with the aid of the 
microscope, developing peculiarities of structure which identified it with can- 
cer. The softened parts yielded a very peculiar creamy juice, which contained 
large nucleated cells, of highly complex character, and resembling those found 
in the decidedly cancerous tumours of the liver, uterus, etc., in this case. The 
juice containing these structures was in the largest softening surrounded by a 
delicate vascular wall, inseparable from the cerebral substance ; and in the 
others, the vessels were distributed through the disorganized cerebral matter, 
giving it exactly the appearance of the so-called " red-softening." There was 
no trace of fibrous tissue in any part of the cancerous substance, which was of 
a yellowish-white colour and pulpy consistence. The case had occurred in the 
female clinical ward of the Royal Infirmary, and the post-mortem examination 
was made by Dr. Gairdner. Dr. M. pointed out the resemblance between this 
case and another case of cancer of the brain, recorded by Dr. Redfern, in the 
Monthly Journal of Medical Science, vol. xi. p. 510, which had also been remark- 
able for containing no fibrous tissue. He concluded by making a few remarks 
* on the asserted essentiality of fibrous tissue to the constitution of cancer. 

Dr. Bennett stated that he had been of opinion that nucleated cells, im- 
bedded in a fibrous stroma, constituted the best definition of cancer, until the 
publication of Dr. Redfern's case. He still believed that the detection of such 
a fibro-cellular structure would prove most useful in enabling us to separate 
cancerous from fibrous, epithelial, and other growths. The observation of Dr. 
Redfern, together with the present case, the cancerous formation in the brain 
of which he had carefully examined, proved that nervous texture constituted 
an exception. This was the first decided case of encephaloma in the brain 
that had come under his notice. 

Dr. W. T. Gairdner said, that this was a remarkably satisfactory case, as 
illustrating the nature of the assistance furnished by the microscope in the 
investigation of cancer. In performing the dissection, he had been struck with 
the peculiar character of the softenings, and the creamy juice contained in the 
largest of them ; and considering their occurrence in connection with cancer of 
other organs, and without the usual accompaniments of cerebral softening — 
such as disease of the vessels — he had been led from the first to believe the 
cerebral lesion of cancerous origin, and had afterwards found all doubt on the 
subject removed by the very peculiar microscopic structure of the softened 
parts of the brain. It so happened, also, that a similar conclusion was arrived 
at, quite independently, by Dr. Murchison, and likewise by Dr. Bennett ; while 
there could be no question that, but for the microscopic examination, it Avould 
have been impossible to have formed a clear idea as to the character of the 
lesion ; and anything less than a most careful and minute examination would 



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[Jan. 



have been very apt to lead to its being recorded as an ordinary case of cerebral 
softening. — Monthly Joum. Med. Sci. Aug. 1852. 

48. On Cancroid, or Epithelial Cancer. By M. Maisoxneuve. — This affec- 
tion has the greatest possible resemblance to cancer, deceiving the most expe- 
rienced eye and the most matured practitioner, so that without the intervention 
of the microscope, it would probably always have continued impossible to re- 
cognize its true nature. Surgeons were, indeed, aware that certain cancers of 
the most hideous aspect, and most fetid smell, were capable of being removed 
by operation without relapse occurring, and that a cure was still sometimes 
obtainable after one or more relapses, notwithstanding that the neighbouring 
glands had become invaded. They were also aware that some of these dis- 
tressing affections could go on corroding the surface for years, without infect- 
ing the entire organism, and without inducing cachexia; and that, at last, they 
led to death much rather by inducing local disorders than by general infection. 
These facts were regarded as peculiarities of evolution, the reason of which 
was quite unknown ; but the microscope, by revealing to us the fact that these 
peculiarities are dependent upon special anatomical characters, has enabled us 
to constitute a distinct family in the class of cancers, under the name of can- 
croid, or epithelial cancer. 

Examined by the microscope, its essential character is the epidermic cell, 
which may easily be recognized by its distinct outline and regular form, and 
especially by its small and rounded nucleus. These cells are often seen agglo- 
merated together into rounded bodies, which have been termed epidermic globes. 
The epidermic matter does not present itself under the lactescent or emulsive 
appearance of cancer, but under that of a whitish substance, having the con- 
sistency of soft paste, and spreading out in water in a lamellar form. It is 
sometimes seen in little rounded masses resembling tubercle ; but it is oftenest 
infiltrated into the tissues which it invades, whence it can be squeezed or 
scraped. It always originates in an external or internal tegumentary surface, 
naturally covered with epithelium — as the skin, mucous membrane, or even 
serous membrane; but when it takes an extension, the epidermic infiltration 
may penetrate to great depth in the various tissues. It frequently invades the 
lymphatic glands, which are in immediate relation with the diseased parts; 
but when it has even passed this barrier, it never determines a general infec- 
tion, or even a cachectic state of the economy. 

This absence of infection is the capital point in its history, and the one 
which, in a clinical point of view, constitutes its essential distinction from 
true cancer. Anatomy and physiology seem to afford an explanation of this 
difference. Thus, in considering the mode of nutrition of our healthy tissues, 
we find that the cells of which they are composed are constantly undergoing 
absorption and elimination through the natural emunctories. As in cancroid, 
the fundamental cell is nothing else than normal epidermis, or epithelium, 
it is easy to see that if absorption carries it into the torrent of the circula- 
tion, it will be eliminated by the regular channels, and give rise to no gene- 
ral disturbance. But in certain morbid products, and especially cancer and 
pus, the volume of the cell is no longer in natural relation to the paren- 
chyma of the different secretory organs, so that, if by any means it gains 
admission to the circulating stream, it has no opportunity of obtaining an 
exit, and becomes detained in the midst of the tissues, only to excite disorder. 
To simplify this view of the case, we have only noticed the difference in size 
of the cell, and especially of the nucleus ; but many other differences, both 
chemical and vital, may exert an influence which we are unable to determine. 

As we have no means of modifying the vitality of the tissues which secrete 
this abnormal quantity of epidermic cells, and no agent capable of inducing 
their absorption, their destruction is the only source left us ; and for this 
purpose, M. Maisonneuve prefers caustics to excision or ligature. The caustic 
not only removes the diseased part, but modifies the condition of the tissue 
that secreted it; and, in fact, this means was preferred by most surgeons 
even before the microscope had revealed the difference between this affec- 
tion and true cancer. Some caustics are preferable to others, seeming to 



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231 



exert almost a specific effect upon the epidermic cells, as the arsenious acid 
and nitric acid. The first of these not only acts upon the parts it is applied 
to, but it is also absorbed by the lymphatics, and may thus pursue the epi- 
dermic molecules into these organs. — Brit, and For. Med.-Chirury. Rev. Oct. 
1852, from Gaz. des Hopitaux, No. 28. 

49. Statistics of Operations for Cancer. — In our No. for July last, p. 259, we 
have given an extract from the first lecture by Professor Paget before the Royal 
College on this subject. In a letter, since published in the London journals, 
the Professor qualifies the statement there made. He says " that the state- 
ment had reference to cases of scirrhous cancer of the breast. In such cases, 
I believe that the general average duration of life, after the patient's first ob- 
servation of the disease, is forty-nine months ; that the average life of those 
whose breasts are removed, and who survive the effects of the operation, is 
forty-three months, and that the average life of those in whom the disease is 
allowed to run its course is about fifty-five months. 

" In the second lecture, I said that the general result of operations for medul- 
lary cancers is very different ; and that, although they are so seldom long sur- 
vived that they are generally considered to be less beneficial than the opera- 
tions for scirrhous cancers of the breast, yet, on the whole, they are more so. 
The general average of life of persons affected with medullary cancer of the 
eye, testicle, breast, bones, or other external organ, may be reckoned at about 
twenty-four months from their first notice of the disease; but I believe the 
average for those from whom the primary disease is removed, and who do 
not die in consequence of the operation, is about thirty-four months ; while 
the average for those in whom the disease is allowed to run its course is 
scarcely more than a year. 

" In the third lecture, I expressed the belief that, on the whole, the opera- 
tion for epithelial cancers is even more effective in prolonging life than the 
operation for medullary cancers ; but that the wide diversities in the dura- 
tion of life amongst those affected with this form of cancer, make it very 
difficult, at present, to deduce such an average as may be relied on. And I 
would repeat what I said in one lecture respecting all these averages — 
namely, that such general results deserve only general -consideration in the 
treatment of particular cases of cancer. They may justly determine a gene- 
ral rule of action, but it can be only such a rule as must admit of numerous 
exceptions. In many cases of scirrhous cancer there are sufficient reasons 
for operating; and, in many cases of medullary and epithelial cancers, rea- 
sons as sufficient for refraining. The right course must, in each case, be de- 
termined by a just appreciation of all the conditions each presents. 

50. On Discharge of Fluid from the Nipple in Innocent Tumours of the Breast. 
— M. Richard observes that while in cancerous tumours, which in their growth 
induce atrophy of the mammary gland, no discharge from the nipple takes 
place, innocent tumours, as partial hypertrophy of the gland, or cystic growths, 
are always attended with more or less discbarge or oozing, the fluid being some- 
times syrupy or adhesive, and at others bloody. Repeated opportunities of 
observation have convinced him that this is a valuable diagnostic and prog- 
nostic sign. — Rev. Med. Chirury. torn. xi. 

51. On the Treatment of Epistaxis. — M. Reveille-Parise observes that it is 
very desirable to be in the possession of a simple means of arresting epistaxis 
when severe. Plugging is not the simple operation it has been described; it 
is very tedious, and often excites vomiting or sneezing, which aggravates the 
bleeding. Moreover, we may not have any appropriate instrument at hand. 

He has found three means of great utility: 1. Alcohol, applied upon dossils 
of charpie, is a most energetic styptic. It causes a strong or even a temporarily 
painful sensation, and often speedily checks the bleeding. The essential point 
is, before passing in the alcohol, to dry the nostril well by blowing the nose, 
and by charpie. 2. Equal parts of powdered gum and alum maybe blown into 
the nares, and dossils rolled in the mixture then applied, a 'magma which 



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[Jan. 



arrests the hemorrhage, being speedily formed. Before removing the dossils, 
they require to be well moistened with tepid water when the bleeding has quite 
ceased. 3. The best of all means is, however, the application of carded cotton- 
wool; and it is surprising that surgeons have hitherto made so little use of this 
haemostatic agent. After the nostril is well dried, dossils of pure clean cotton 
should be passed in, until it is filled. They must not be too tightly rolled, or 
the blood cannot penetrate the interstices, nor too loosely, or it wiil do so too 
easily, and the hemorrhage will continue. — Bulletin de Th6rapeutique, torn. xlii. 
p. 308. 

[Other correspondents of the same journal speak also of the great utility of 
closing the alas nasi with the fingers, either as the sole or adjuvatory treatment; 
also of the compression of the carotid on the same side as that on which the 
bleeding occurs.] — Brit, and For. Med.-Chirurg. Review, Oct. 1852. 

52. Sal Ammoniac in Enlarged Prostate. — M. Fischer, of Dresden, has long 
been in the habit of administering the sal ammoniac in large doses, in chronic 
enlargement of the prostate ; and since he published an account of his suc- 
cess with it in 1831, various other German practitioners have supplied cor- 
roborative testimony. Seeing that surgical treatment is so often inefficient, 
this means would seem to supply a valuable resource, and this especially as 
it may be employed in conjunction with other remedies. In the present pa- 
per, M. Vanoye relates two cases in addition, in which the success obtained 
seems quite to justify former encomiums. In both, the gland became pro- 
gressively and greatly diminished in size. Large doses are, however, required. 
We may commence with fifteen grains every two hours, and go on to double 
or treble this quantity, so that nearly half an ounce is taken per diem. When 
the dose given is too great, we are admonished by disorder of the digestive 
organs, a miliary eruption, profuse sweats, and especially by scorbutic symp- 
toms. These ill effects may be prevented or diminished by the employment of 
mucilaginous vehicles, bitter extracts or aromatics, and a good animal diet. 
Persons suffering from hemorrhagic disposition, or affections due to poverty of 
blood, should not be subjected to this treatment. — Brit, and For. Med.-Chirurg. 
Rev. Oct. 1852, from Bulletin de The'rapeutique, torn. xlii. 

53. Dislocation of the Humerus forwards and upwards. — Mr. E. G, H. Butcher 
records (Dublin Medical Press, October 20, 1852) the following well-marked case 
of dislocation of the humerus forwards and upwards : — 

Eliza McMahon, aged 35, a large muscular woman, was admitted into Mer- 
cer's Hospital at 8 A. M., October 3, 1852, under my care. On the evening 
previous to her admission, at 11 o'clock, she was disorderly in the street, and 
being taken up by the police, she offered great resistance against being taken 
to the station-house. In the struggle that ensued, she says she remembers 
having got a very violent twist in the right arm, which gave her the most excru- 
ciating pain. She was retained all night as a prisoner, and brought on the 
following morning, at the time specified, to the hospital, nine hours having 
elapsed from the period of the receipt of injury. 

On stripping the chest and shoulders, the deviation from symmetry was 
marked and striking. Circumstances combined to render the outlines of the 
injury prominent — viz., a few hours had only passed from the moment she sus- 
tained the accident; therefore, effusion had not time to set in and round off 
the irregularities created by the new position of parts. Again, the patient, 
though large and full, had the muscular system well developed, with scarcely 
any deposit of fat. 

The most prominent features of the accident were the following: There was 
flattening of the shoulder and prominence of the acromion far greater thanin 
the dislocation into the axilla. The deltoid was not only flattened and flaccid, 
but likewise twisted forwards, the fibres attached to the posterior edge of the 
acromion participating most in this puckering of the muscle. The head of the 
bone formed a remarkable tumour to the sternal side of the coracoid process, 
corresponding to the centre of the clavicle, and about half an inch below its 
inferior edge ; so prominent was the swelling that the coracoid process could 



1853.] 



Surgery. 



233 



very indistinctly be felt as it lay buried external to it. The axis of the shaft of 
the humerus was directed from this point, about the centre of the clavicle, 
slightly backwards ; at the same time, it lay close to the side — a position quite 
contrary to the descriptions given by writers on the subject. In another in- 
stance where I was consulted very recently, the limb also hung close to the side, 
and its other characteristics were as marked as in the present instance. The 
amount of shortening, measured with the greatest accuracy, was more than half, 
and very nearly three-quarters of an inch. Now, this fact was verified by the 
observation and measurement of others as well as myself. All the movements 
of the joint were greatly restrained. Any attempt at bringing the limb forward 
was productive of great pain, and at once interrupted by the head of the bone 
being tilted against the coracoid process. Backward motion was restrained by 
the action of muscles, and the carrying of the limb outwards was prevented by 
the opposition of the clavicle to the head of the bone. 

I readily reduced the dislocation in the following way : Having placed the 
patient on the side of the bed in which she had been lying, in the sitting pos- 
ture, a folded sheet was passed round the chest, close under the injured part, 
and the ends given to an assistant who stood at the opposite side of the bed; 
thus counter-extension was provided for. Standing on the right side of the 
patient, with my left foot resting on the edge of the bedstead, I brought the 
luxated arm over my knee, and made forcible extension downwards by means 
of a jack-towel previously fastened and secured by the clove hitch round the 
humerus at its lower end : thus, the head of the bone was moved downwards 
below the coracoid process. The extending force was then directed outwards, 
and a little forwards, by the aid of an assistant, and the head of the bone was 
quickly drawn up to the glenoid cavity, and restored with an audible snap. By 
placing the patient on the side of the bed, instead of on a low chair, as is usu- 
ally done, I gained great additional power by bringing into acquisition the 
weight of my body and shoulder in forcing down the extending band in the 
manner described. 

After the reduction was effected, the limb was bandaged to the side, and the 
elbow supported by a sling tied over the opposite shoulder. Surgical authori- 
ties are somewhat divided as to whether the arm be shortened or lengthened in 
the dislocation of the humerus forwards. In the cases which I have seen, and 
as noticed in the one just mentioned, the shortening amounted to more than half 
and nearly three-quarters of an inch. 

54. Pelvic Abscesses. — [The Dublin Medical Press (Jan. 7, 1852) contains some 
very interesting practical observations on pelvic abscesses, by Dr. Fleetwood 
Churchill, so well known in this country by his valuable writings. 

Dr. Churchill has observed pelvic abscess under various circumstances.] 

1. It may occur, not only unconnected with parturition, but in unmarried 
persons, at different ages, and independent of all the ordinary irritants of these 
organs. A case occurred in the person of one of the nurses at the Meath Hos- 
pital, a single woman, about 50 years of age, and without apparent cause. It 
exhibited the usual symptoms, which I shall notice by and by, and ran the 
usual course, softening and opening into the rectum, after which the patient 
recovered. 

2. I have seen several cases of the disease in married women who never had 
had children. In two instances, it occurred within a few months of marriage ; 
in both, the tumefaction was considerable ; but both terminated in resolution. 

3., In some few cases, it occurs as a secondary complication of severe uterine 
irritation, apparently from the use of local irritants, the two frequent employ- 
ment of the uterine sound, the introduction of the pronged pessary, &c. 

4. I have seen the disease follow a smart attack of ephemeral fever several 
times : in one case it terminated in resolution, after several weeks ; in another, 
in suppuration and evacuation by the rectum ; and a third is at present under 
treatment. 

5. It not unfrequently complicates or terminates an attack of simple hys- 
teritis, of which several examples have come under my notice, terminating most 
generally in suppuration. One such case was the largest abscess of the kind I 



234 



Progress of the Medical Sciences. 



[Jan. 



have ever seen, occupying about one-fourth of the abdomen ; and in another, at 
present under my care, the tumour acquired the size of an orange, and after 
remaining stationary for some months, is now nearly resolved. 

6. In certain epidemics of puerperal fever, inflammation of the uterine ap- 
pendages appears as a special variety, with or without a corresponding affection 
of the uterus. 

It is not unlikely that the disease may occur under other circumstances. 
[Pathology. — The disease is a phlegmonoid inflammation; but the cases may 
be divided into two classes, as regards their locality.] 

1. The first and largest exhibits a tumour just above the brim of the pelvis, 
and closely connected with it, fixed and immovable, extending downwards in- 
ternally outside the vagina, through the sides of which it can be felt. 

2. In the second class, the tumour is distinct from the pelvis, rounded, and 
quite movable in every direction. 

In the latter cases, the inflammation appears limited to the uterine append- 
ages ; i. e., the ovary, broad ligament, and Fallopian tubes. In the former, the 
soft parts which line the anterior and lateral wall of the pelvis are also involved 
in addition to the uterine appendages; these are more properly named pelvic 
abscesses. 

[Although either side indifferently may be affected, Dr. C. thinks the left side 
is more frequently the seat of the inflammation.] 

Causes. — 1. In certain cases, the abscess is undoubtedly the result of mecha- 
nical injury, and the cause is quite intelligible. 

2. In others, again, there would appear to be a sort of metastasis of inflam- 
mation from the uterus, which in these cases occurs towards the termination of 
the uterine affection. 

3. In a third class of cases, especially when the patient is unmarried, it 
seems more fairly attributable to cold than to any other cause ; but what may 
be the influence which determines the attack to this region, it is quite impossi- 
ble to say. In one of the cases to which I have alluded, all the uterine func- 
tions had been some time quiescent. 

4. Lastly, in puerperal epidemics, when the uterus is involved, we could 
hardly expect that its appendages would escape ; and accordingly we find that 
they generally share in the disease, though much more remarkably in some 
epidemics than in others. In another place, I have given statistics of the com- 
parative frequency. _ 

[Symptoms. — The disease may, and generally does, Dr. C. thinks, commence 
by a febrile attack; but this is not always the case. There may be a rigour, 
followed by heat, or this may be entirely absent. Sooner or later, the patient 
complains of pain or uneasiness in the lower part of the abdomen; but the 
amount of suffering varies a good deal, and pretty much in accordance with the 
amount of fever.] 

If we examine the abdomen carefully, we shall either find a tumour just 
above Poupart's ligament, of varying size and thickness, and firmly fixed to the 
pelvis; or a movable tumour, rounded, firm, and elastic, lying above the pelvis 
in the abdomen. 

In the former class of cases, a vaginal examination adds nothing to our in- 
formation, as the tumour is out of reach ; but in the latter we can trace it 
extending more or less down into the pelvis, adding a lateral thickness, ex- 
tremely tender on pressure. Generally speaking, the uterus is pushed a little 
to one side, is not tender on pressure, but moving it gives pain. In one or two 
cases, I have seen the uterus fixed and nearly immovable ; in one case only 
have I seen both sides affected. This occurred in a married woman, uncon- 
nected with delivery. 

In the former class, also, in addition to the pain, tenderness, &c, the move- 
ments of the leg of that side are affected; the patient cannot stretch it out 
straight without great pain, nor can she walk or stand up without bending for- 
ward. 

In the latter cases, the movements of the limb are quite unaffected. This 
distinction is, I think, of considerable practical value. 



1853.] 



Surgery. 



235 



The tumour, I have said, varies in size : it is, however, always tender on pres- 
sure, and not less so as the disease advances. When it attains a considerable 
size, or is attended with much irritation, I have seen the bladder and rectum 
sympathetically affected ; the former more frequently so, giving rise to a fre- 
quent desire to evacuate their contents. In only one case have I had reason to 
believe that the tumour offered a mechanical impediment to the passage of the 
feces. 

These, sir, are the principal symptoms present in a simple case of pelvic ab- 
scess ; but they, as well as the course of the disease, will vary much according 
to the extent of the local affection, the amount of constitutional disturbance, 
and, in some degree, according to the circumstances under which the attack 
has occurred. 

1. In some cases I have seen, the affection had a purely local character. 
There was the tumour, tender, firm, movable, or immovable ; but the pulse was 
scarcely quickened from beginning to end: the appetite but little affected; the 
bowels regular, &c. The patient was confined to the sitting or recumbent pos- 
ture, and suffered pain locally, but that was all. 

2. In other cases, the local suffering was very considerable and unceasing ; 
the pulse very quick, at least 120, with sweating at night ; utter loss of appe- 
tite; irregularity of bowels ; no sleep, and great emaciation. 

3. Lastly, the cases which occur during an epidemic of puerperal fever will 
present its general characters in addition to the local symptoms already men- 
tioned. 

With more or less of these symptoms, but with the local ones always, the 
disease runs its course not quickly : often, on the contrary, very slowly, but 
with an uncertain duration in each case. I do not think I ever saw the tumour 
disappear or suppurate in less than a month ; and I have known it run on to 
three or four, as in two cases at present under my care. 

The disease may terminate either by resolution or suppuration. 

1. By resolution. I have seen repeated instances of this termination, both 
when the tumour is free and when it is attached to the pelvis, though more 
frequently in the former than in the latter, and much more frequently in those 
cases where there is but little constitutional irritation. In such cases, the 
tumour may increase to a certain degree with the symptoms I have described ; 
it then remains pretty stationary for a time, often a considerable time, after 
which it gradually and slowly subsides. It is worthy of notice, that if the 
patient be imprudent during this process, the morbid action in the tumour may » 
be re-excited, and the case may terminate in another manner. In one of my 
cases the tumour had nearly disappeared, when the lady's servant became sud- 
denly insane, and so frightened her that the tumour enlarged, and all the symp- 
toms reappeared. The time occupied by the process of resolution is generally 
considerable. I have two cases under my care, at this moment, illustrative of 
this ; in one, the tumour, which was free, has all but disappeared, after nearly 
five months ; and, in the other, the fixed tumour has considerably diminished, 
after three months. 

2. In the majority of cases, however, the tumour suppurates, softens, gene- 
rally perceptibly, and, after a process of absorption of the intervening tissues, 
terminates by the evacuation of the purulent matter ; this formation of matter 
being generally, though not always, marked by the occurrence of rigors. The 
channel through which this takes place varies a good deal. 

1. In some cases, it has been evacuated into the peritoneum, giving rise to 
peritonitis; but this must, I think, be very rare, at least in upwards of twenty 
cases which have come under my notice it never occurred. I recollect a case 
which occurred to my friend the late Dr. Haughton, which now appears to me 
to have been a case of the kind. The poor woman had recovered badly from 
her confinement, and some time afterwards, when at the night-chair, she felt 
something give way, and peritonitis immediately followed. 

2. Cases are on record, in which the abscess opened into the bladder. If I 
mistake not, I saw one recently in one of the journals ; but such cases I believe 
to be the most uncommon of all. 

3. The tumour may soften at its lower part, and the matter may find its way 



236 



Progress of the Medical Sciences. 



[Jan. 



through the coats of the vagina, and be discharged through that canal. I have 
seen several cases of this termination, the results of which have been very favour- 
able. It has been suggested that we should puncture the tumour in this situa- 
tion, when the situation of the softening is suitable; nor do I see any objection 
to the plan. I have, however, not found it necessary. 

4. The most common situation, certainly, for a spontaneous opening, is into 
the rectum, and then the matter will be found discharged along with the stools. 
On this account, when the tumour is observed to become softer, and we have 
reason to suspect that matter is formed, the alvine evacuations should be care- 
fully examined. Except when the matter escapes into the peritoneum, no degree 
of pain seems to accompany its evacuation. It often passes unobserved by the 
patient, and sometimes seems marked by a sense of relief in the tumour. 

5. In a considerable proportion of cases, the tumour approaches the surface 
gradually and engages the integuments, which become tense, fixed, and some- 
times red and shining. Then fluctuation can be felt, the intervening integu- 
ment is absorbed, and the matter points, as it is called. 

The extent of these abscesses, superficially, is generally not much beyond 
the size of the tumour at an earlier period, but in some cases I have seen them 
very large; in one case, scarcely less than one-fourth of the abdomen seemed 
involved. I do not think it would be wise to wait for such an extent of disease ; 
but we ought to open it at an earlier period, and thereby save the patient much 
suffering. 

The symptom which most surely indicates this mode of termination, or rather 
this locality, is the skin becoming fixed over the tumour, not rolling freely, but 
being adherent to it. 

Diagnosis. — There can hardly be any difficulty in the diagnosis of pelvic ab- 
scesses which occur after delivery, and as a part of a more general puerperal 
affection ; the attention being directed to the uterine system, a careful local 
examination will detect the tumefaction, whether it be fixed or not. If it be 
situated deep in the pelvis, and scarcely appearing above the brim, still the pain 
down the leg, and the difficulty of extending the limb, will leave but little 
doubt. 

Perhaps an equally careful examination might be equally successful in the 
unimpregnated condition; but as the disease is not generally expected under 
such circumstances, a less minute investigation may, and often does lead to a 
false conclusion. I have myself known a case of pelvic abscess pronounced to 
be a fibrous tumour by very competent authority. 

Now, the pathognomonic symptoms are, the pain in the tumour and down the 
leg, the impossibility of standing quite upright, or extending the leg com- 
pletely, and the tumour detected on external and internal examination. 

L From fibrous tumours it is distinguished by its comparatively quick growth, 
the amount of uneasiness, and the termination. The former increase very 
slowly, and insensibly give rise to few or no symptoms, and, above all, are not 
common in the uterine appendages. 

2. In women of a certain age, the filling up more or less of the pelvic cavity 
might be supposed to result from cancerous deposition; but here we have no 
general cancerous diathesis, the uterus is always unaffected, and the occurrence 
of suppuration or resolution solves the difficulty. 

3. That one variety of abscess which is unconfined resembles much*ordinary 
ovarian enlargements, at first sight ; but it differs in this, at least according to 
my experience, that it never occurs except in connection with childbirth or mis- 
carriage; and, as a general rule, the growth is much more rapid in the cases 
under consideration. 

The affection, then, may be considered as well marked, and, with care, not 
difficult of appreciation, but requiring special care and attention when it occurs 
independent of parturition. 

Prognosis. — For so serious an attack, involving such important organs, and 
liable to such various terminations, the prognosis is very favourable. I have 
seen more than twenty such cases, and have never seen one in which any un- 
pleasant result occurred. Some fatal cases are on record, but they must be very 
rare, and probably in consequence of secondary peritonitis. 



1853.] 



Ophthalmology. 



237 



The disease is, however, very tedious, and may reduce the patient consider- 
ably, so that there may be some risk of the incursion of other diseases, if the 
patient be predisposed thereto. 

Treatment. — Whether the attack come on after delivery or independent of it, 
if we see the patient during the acute stage, it will be necessary to apply leeches 
over the tumour; to repeat these, if required, in numbers according to the 
amount of irritation and the patient's strength, and to follow them by constant 
poulticing. 

The bowels should be kept quite free, and I have found benefit from small 
and repeated doses of calomel or blue pill, but not continued so long as to affect 
the gums. 

The diet of the patient, during this first period, must be low, and I need 
hardly say that she must be confined to bed. 

After we have somewhat subdued the acute inflammation, we must still con- 
tinue the poultices until suppuration is established; but if the pulse be quiet, 
we may allow a little better diet, such as chicken-broth or beef-tea. 

When we are satisfied that suppuration has taken place, that matter is formed, 
then our anxiety is as to the place where it is to be evacuated. If by the blad- 
der or intestine, we can do nothing but continue the poultices; but if, on a 
vaginal examination, we find the tumour soft and the intervening parietes thin, 
we are advised to make a puncture with a bistoury into the tumour, first ascer- 
taining the presence of pus by an exploring-needle. If we succeed, the after- 
treatment is simple ; so long as purulent matter escapes, the poultice may be 
continued, and occasional pressure made upon the tumour, so as to empty it as 
much as possible. 

But if the tumour enlarges above Poupart's ligament, involves the skin, and 
becomes soft, with a sense of fluctuation, it must be opened freely in this situa- 
tion; and will save the patient some suffering if we make an incision reason- 
ably early. Sometimes a large amount of matter is discharged with great 
relief, sometimes only a small quantity; but the discharge will continue so long 
as suppuration goes on. When it ceases, the poultices may be omitted, and 
some dressing substituted if the wound remains open. 

When once the abscess is opened, we may allow the patient a more generous 
diet, with wine, &c, and in many cases bark may be given with benefit. 

But if the tumour shows a disposition to resolve itself, it will be advisable by 
degrees to leave off the poultices, and substitute cotton wool or flannel. In 
some cases this process is hastened by a small blister applied occasionally, or 
by painting the part with strong tincture of iodine, and 1 have seen great bene- 
fit and improvement result from warm hip-baths twice or thrice a week. 



OPHTHALMOLOGY. 

55. On the Contractile Tissue of the Iris. — [We copy the following interesting 
observations on the contractile tissue of the iris by Joseph Lister, B. A., from 
the first number of the Quarterly Journal of Microscopical Science, Oct. 1852] : — 

Our knowledge of the cause of the movements of the iris was till within the 
last few years in a very unsatisfactory condition. That this organ possessed 
contractile fibres was a matter of inference, not of direct observation. In the 
third part of the last edition of Quain's Anatomy, published in 1848, we find it 
stated (p. 915) that the radiating and circular fibres of the iris are generally 
admitted to be muscular in their nature, but the grounds for that admission 
are not mentioned. Mr. Bowman's Lectures on the Eye, delivered in the sum- 
mer of 1847, and published in 1849, show us that the then state of histology in 
this country did not enable that accomplished microscopical anatomist to iden- 
tify the fibres of the iris with other plain (unstriped) muscular tissue. At page 
49, he says : " The fibres which make up the proper substance of the iris are of 
a peculiar kind, very nearly allied to the ordinary unstriped muscle, but not by 
any means identical with it." He afterwards goes on to argue that, as we 
know that the organ changes its form, and as its vessels are so distributed that 
No. XLIX.— Jan. 1853. 16 



238 



Progress of the Medical Sciences. 



[Jan. 



it cannot be erectile, we have no other resource than to consider its fibres con- 
tractile, which conclusion he supports by reference to the striped fibres in the 
iris of birds and reptiles. 

In 1848, Professor Kolliker announced to the world his grand discovery of the 
cellular constitution of all plain muscular tissue, in a full and elaborate paper 
in the Zeitschrift fur Wissenscliaftliclie Zoologie* At p. 54 of the first part of 
the first volume of this journal, after speaking of the arrangement of the fibres 
of the ciliary muscle, the sphincter pupillae, and dilator pupillse, he makes the 
following statement: "The elements of all these muscles are undoubtedly 
smooth, muscular fibres. In man, I have but seldom succeeded in isolating the 
individual fibre-cells, but I have had more frequent success in the case of the 
sheep, where I found them in the ciliary muscle, on an average, l-600th of an 
inch in length, and l-4000th to l-3000th of an inch in breadth. In man, in all 
these muscles one sees, as a rule, only parallel fibres projecting to a greater or 
less extent at the edges of small fragments of the tissue, these fibres exhibiting 
in abundance the well-known elongated nuclei, either with or without the aid 
of acetic acid. In man, the muscle of the choroid (ciliary muscle) has broader 
and more granular fibres and shorter nuclei than the iris. In the former, the 
nuclei measure from l-2400th of an inch to l-1333d of an inch ; in the latter, as 
much as l-1090th of an inch." 

Here, then, we have, so far as I know, the first and only recorded observa- 
tion of tissue in the iris identical with ordinary unstriped muscle. 

It is to be remarked that, where he alludes in the passage above quoted to 
having in rare cases separated the individual fibre-cells of the muscular tissue, 
Professor Kolliker speaks of the three muscles (ciliaris, sphincter, and dilator) 
collectively ; in other words, that he does not tell us in plain terms that he has 
isolated the fibre-cells of the iris at all. Now, the ciliary muscle is confessedly 
easier to deal with than the iris. Mr. Bowman who speaks so doubtfully of the 
fibres of the iris, says of the ciliary muscle, " the fibres are seen to be loaded 
with roundish or oval nuclei, often precisely similar to those of the best marked 
examples of unstriped muscle." ( Op. cit. p. 53.) Another very eminent micro- 
scopical anatomist has informed me, as the result of his experience, that it was 
easy to identify the tissue of the ciliary muscle with that of other organic mus- 
cle, but that this had not been the case with the iris. That Professor Kolliker's 
isolation of the fibre-cells of the muscles of the eye was in reality confined to 
the ciliary muscle is rendered probable by the fact that, while the whole article 
quoted from shows a manifest desire on the part of its author to give all avail- 
able detail, yet regarding the iris he mentions no facts requiring isolation of 
the fibre-cells for their determination ; while, on the other hand, he tells us 
that the fibre-cells of the iris are narrower than those of the ciliary muscle, 
and gives the length of the nuclei in the human iris — things which are very 
readily observed without isolation of the fibre-cells. His figures refer to the 
human ciliary muscle alone ; and the only measurements given by him of mus- 
cular fibre-cells from the eye refer to the same muscle in the sheep. 

It would seem, then, that with regard to the iris, Kolliker's proof falls short 
of the test of isolation of the fibre-cells. 

* Professor Kolliker may almost be said to have been anticipated in this discovery 
by Mr. Wharton Jones. Through the kindness of that gentleman, I have now before 
me two original drawings, made by him about the year 1843, of plain muscular tissue 
from the small intestine. In one of these the muscular fibre-cells are character- 
istically shown, except that their nuclei are not apparent ; one of them is wholly 
isolated. In the other drawing, the alternate disposition of the fibre-cells is seen 
after the addition of acetic acid. He also observed, as he informs me, that the 
unstriped muscle of the oesophagus and stomach, and also of the uterus and other 
organs, consisted of similar elements — a fact which he yearly communicated to his 
class in his public lectures at Charing Cross Hospital. He was led, from appearances 
in the embryo, to infer that striped muscular fibre is originally composed of similar 
elements, which, in the process of development, are inclosed in a sarcolemma com- 
mon to many of them, and become split into fibrillse. He thus accounted for the 
nuclei of striped muscular fibre, which, according to this view, are the persistent 
nuclei of the primitive muscular fibre-cells. — J. L. 



1853.] 



Ophthalmology. 



239 



An operation for artificial pupil, by excision, performed by Mr. Wharton 
Jones, at University College Hospital, on the 11th of August of the present 
year (1852), placed in my possession a 
perfectly fresh portion of a human iris, 
and, without knowing that Kolliker's 
observations had extended to the mus- 
cles of the eye, I proceeded to avail 
myself of this somewhat rare opportu- 
nity of investigating the muscular tis- 
sue of the human iris. On placing 
under the microscope, four hours after 
the operation, portions of the tissue 
carefully teased out in water with nee- 
dles, I found that some of the muscular 
fibre-cells had become isolated, and 
presented very characteristic appear- 
ances. I accordingly made camera lu- 
cida sketches of the finest specimens, 
which are reproduced on a smaller 
scale in the accompanying figures. (See 
Fig. 1-6.) I drew the last cell (Fig. 2) 
nine and a half hours after the opera- 
tion. And here I may mention that I 
have not found the muscular fibre-cells 
by any means a very perishable tissue. 
After an iris has been soaking two or 
three days in water, the muscular tissue 
of the sphincter is still quite recogniza- 
ble, not only by the nuclei, but also by 
the individual fibre-cells. 

Of the figures above referred to, (1) 
and (2) are examples of the most elon- 
gated cells that I saw. By reference to 
the scale, it will be found that the cell 
(1) is about l-125th of an inch in 
length, and about l-3750th of an inch 
in greatest breadth ; while (2) is a little 
shorter, but of about the same average 
breadth. Kolliker divides muscular 
fibre-cells into three artificial divisions, 
according to their shape, of which the 
third contains the most elongated and 
most characteristic cells. Of this third 
division, the cells (1) and (2) are good 
examples, and, in fact, correspond in 
their measurements to average fibre- 
cells of the muscular coats of the intestines. The cells (3) and (4), though less 
characteristic in respect of their length— (3) being about l-333d of an inch in 
length, and l-3000th of an inch in breadth, and (4) l-300th of an inch by 
l-3(300th of an inch, yet present the same peculiar delicate appearance and soft 
outline, and the same elongated nucleus of not very high refractive power rela- 
tively to the contents of the cell, but clearly defined. All these cells have the 
same flat or ribbon-like form which is exhibited by the cell (2) at {a), where 
one edge has become turned up by a folding of the cell ; at (6) there seemed a 
tendency to transverse arrangement of the granules of this cell, which tendency 
is more strikingly exhibited at b and c in the cell (5), which, though not iso- 
lated, is introduced on that account. This tendency to transverse arrangement 
of the granules was long since noticed by Mr. Wharton Jones, as that gentle- 
man has since informed me, and is, indeed, indicated in the drawings which 
are alluded to in the note above. In the cells of this iris, however, it was not 
by any means constant. Some of them, as (1) at (a), and (3) at (a) and (b), 




2-10 



Progress of the Medical Sciences. 



[Jan. 



exhibited something of a longitudinal arrangement of the granules, such as 
was noticed some years since in unstriped muscle by Mr. Bowman, who con- 
sidered the rows of granules as an approach to the fibrillse of striped muscle. 
These cells are more granular than I have found those of the iris of the horse 
to be ; but I may here mention that, on comparing with these drawings the 
outline of a fine specimen of a muscular fibre-cell of the sphincter pupillas of 
this animal, which I had sketched by the camera lucida, I find it to be almost 
an exact counterpart of the cell (1) as regards the shape and size of both the 
cell and its nucleus. The nuclei of these cells measure from l-1400th to 
l-1110th of an inch in length, and about l-9500th of an inch in breadth. They 
are not, however, the most characteristic that are to be found in the iris. Fig. 
6 is from a camera lucida sketch of a nucleus of the sphincter pupillse of a 
horse ; it measures l-840th by 1-15, 200th of an inch, and exhibits in a very 
marked manner the true rod-shaped figure which appears peculiar to muscular 
fibre-cells. On the other hand, I found some instances in the human iris of 
fibre-cells with considerably broader nuclei than those in the figures. The iris 
that yielded these cells was a blue one, apparently perfectly healthy ; it was 
active and brilliant before the operation, which was performed on account of 
central opacity of the cornea, resulting from an attack of a severe form of oph- 
thalmia fifteen months previously. I watched the case closely from the first, 
and there was no reason to suspect implication of the iris in the inflammation. 

Having thus satisfactorily verified the fact of the existence in the iris of 
tissue identical with ordinary unstriped muscle, I was naturally led to inquire 
into its distribution in the organ ; and, as this is a subject of great interest, and 
one about which much difference of opinion has prevailed, I may mention here 
the facts which I have hitherto observed, although there be not very much of 
actual novelty in them. 

Kolliker, in the article above referred to (loc. cit. pp. 53 and 54), describes a 
sphincter and dilator pupillse, the former " very readily seen in the white rab- 
bit, or the blue iris of man, from which the uvea has been removed, about a 
quarter of a line broad in man, exactly forming the pupillary margin, and 
situated somewhat nearer the posterior surface of the iris." Of the dilator he 
says, while confessing the difficulty of the investigation, that he believes it to 
consist of many narrow bundles, which run inwards separately between the 
vessels, and are inserted into the border of the sphincter. 

Bowman, on the other hand, states [op. cit. p. 48) that, while in some in- 
stances a delicate narrow band of circular fibres exists at the very verge of 
the pupil, yet, in the majority of instances, he feels sure that no such con- 
strictor fibres of the pupil exist. He ascribes the contraction of the pupil to 
the inner part of the radiating fibres, which, he says, are joined and knotted in 
a plexiform manner round the pupil. It is scarcely needful to observe that 
such a statement from such an authority could not but go far to impugn Pro- 
fessor Kolliker's assertion respecting the existence of a sphincter pupillae. 

My experience, I must confess, accords with that of Kolliker, viz , that the 
sphincter is readily seen, while the dilator is that whose investigation alone 
presents very serious difficulty. In the first iris that I examined with a view 
to the distribution of the muscular tissue, I was struck, after removing the 
usual pigment, with the appearance of a band on the posterior surface of the 
iris, near the pupil and parallel to its margin, quite evident to the naked eye, 
elastic and highly extensible. This proved to be the thickest part of the 
sphincter pupillae. I have examined six human irides with reference to the 
distribution of the muscular tissue, but in none have I had any difficulty in 
recognizing the sphincter, which I have also found equally distinct in some of 
the lower animals, viz., in the rabbit, the guinea-pig, and the horse. In man, 
I find it about l-30th of an inch in width, thickest towards its outer part, 
where it lies nearer the posterior surface of the iris than the anterior, and thin- 
ning off towards the pupil, where it forms a sharp margin, covered apparently 
on its anterior aspect only by some vessels and nervous threads, and a deli- 
cate epitheliated membrane, which is thrown into beautiful folds when the 
pupil is contracted. The fibres of the sphincter are not absolutely parallel, and 
this deviation is probably produced in part by the dilating fasciculi sweeping 



1853.] 



Ophthalmology. 



241 



in at various parts in a curved manner, and becoming blended with the sphinc- 
ter. The reason for this supposition will appear hereafter. By teasing out 
under the microscope a portion of the actual pupillary margin, I found the 
sphincter to consist at this part of apparently unmixed muscular fibre-cells, 
without any connecting cellular tissue. Fig. 7 is a camera lucida outline of 
the edge of a portion of the sphincter so prepared, which edge is seen to be 
formed of projecting fibre-cells, and similar appearances may be seen with 
great readiness under a high power, after stroking the pupillary margin with 
the point of a needle. Indeed, the great facility with which the tissue may be 
thus broken up appears opposed to the idea of the fibre-cells being united end 
to end into fibres, as the description formerly given of unstriped muscle would 
lead one to suppose. The ends appear to separate as readily as the edges and 
surfaces, and it would rather seem as if the fibre-cells of a fasciculus were 
placed with their long axis in one direction, cohering generally to one another, 
but without the formation of longer fibres than each cell itself constitutes. I 
may here mention incidentally that in the circular coat of the aorta of the 
sheep, where the muscular tissue is disposed in thin layers among the elastic 
tissue, I have observed a distinctly alternate arrangement of the fibre-cells 
without any formation of fibres. Mr. Wharton Jones's drawing of alternately 
disposed fibre-cells in the small intestine has been alluded to in the note above. 
A portion of the outer and thicker part of the human sphincter pupillse proved 
also extremely rich in muscular fibre-cells. In the rabbit and guinea-pig the 
sphincter has much the same appearance as in man, whereas in the horse it 
forms a wide but very flat band. 

The dilating fibres of the iris present a very difficult subject of investiga- 
tion. 

And here I must express my belief — a belief the result of repeated and very 
careful observations — that the fibres described by Mr. Bowman as probably 
the contractile fibres of the iris are in reality the outer cellular coats of the 
vessels. The outer coat is very abundant in the vessels of the iris, and indeed 
even in the blue eye towards the sphincter quite obscures the base of many of 
the vessels, and prevents the recognition of their vascular character, which can 
only be determined by tracing them to their more external and more obviously 
vascular trunks. The distribution of these vessels, radiating between the 
sphincter and the circumference of the iris, and forming in the region of the 
sphincter a close and knotted plexus, corresponds accurately with Mr. Bow- 
man's description of the distribution of the fibres of the iris. His account of 
the tissue of these fibres, which he considers as probably contractile, harmo- 
nizes with the characters of the cellular tissue that clothes the vessels. This is 
peculiar ; consisting of very soft-looking fibres, whose fascicula often require the 
best aid of a first-rate glass to resolve them into their constituent elements ; 
destitute apparently of yellow elastic fibres, as in the case of the cellular tissue 
of the uterus, but, like this, containing abundance of free nuclei, of roundish 
or elongated form. The fibres are completely gelatinized by acetic acid. Now 
such a tissue can hardly, in the present state of our knowledge, be regarded as 
contractile ; at any rate, if we can find any ordinary muscular tissue to account 
for the dilating action. On teasing out portions of the outer part of the human 
iris, I have found long delicate fasciculi, whose faint outline, absence of fibrous 
character, and possession of well-marked elongated nuclei, parallel to the 
direction of the fasciculus, left no doubt in my mind that they were plain 
muscular tissue. 

So far my observations regarding the dilator agree with Kolliker's, but whe- 
ther or not these fasciculi are connected with the cellular coat of the vessels I 
have hitherto been unable to determine. 

Among the lower animals, the albino rabbit and guinea-pig appeared but 
little suited for the elucidation of this point. I have been most successful with 
the eyes of a horse, where, from the thickness of the iris and the abundance of 
pigment (for the eyes were black ones), I anticipated but little result from my 
examination. Having removed the uveal pigment from behind, I found that I 
was also able to strip off from the anterior surface a tough membrane, a por- 
tion of which, put under the microscope, appeared to be made up of peculiar 



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[Jan. 



short felt-like fibres, which were gelatinized by acetic acid. At and near the 
pupillary margin this membrane comes off in a continuous layer, leaving a deli- 
cate reticular structure, which contains the muscular tissue. It also contains, 
vessels, as I proved by injection, and a black network, which consists of fine 
fibres, yellow, and highly refracting, more or less incrusted with pigment. I 
am uncertain whether or not this be a network of divided nerve-tubes with 
adhering pigment ; in some spots the pigmental crust was absent from a con- 
siderable length of the fibres. The sphincter pupillae is beautifully seen as a 
broad flat band, of extremely well-marked, unmixed, muscular fibre-cells ; but 
crossing this at right angles are found, here and there, other flat bands of 
fibre-cells, which are in so thin a layer that without isolation the width of the 
individual cells can be seen, and they are evidently of similar dimensions to 
those of the sphincter. On addition of acetic acid their nuclei are also seen to 
be exactly like those of the sphincter. These bands divide in their course 
towards the pupil into several fasciculi, some of which cross over the sphincter 
at right angles till very near to its pupillary margin, and then seem to blend 
with the sphincter by making a slight curve. Most of the fasciculi, however, 
arch away earlier from their first course and join the sphincter in more or less 
oblique lines. The bands from which these fasciculi diverge may be traced 
away from the pupil for some distance, continuing their course at right angles 
to the sphincter till they are obscured by other tissues. Hence, I think the 
inference may fairly be drawn that these are the insertions of the dilating mus- 
cular bundles. In the horse, then, the dilating fasciculi appear to consist of 
precisely the same tissue as the sphincter, and to blend with it in their inser- 
tion. The flat bands of muscular tissue above spoken of seemed to have no 
special relation to the vessels, some of which were filled with injection. In 
the outer part of the iris of the same horse, I found a delicate muscular fasci- 
culus lying near but not intimately connected with one of the radiating vessels 
of this part. In the human iris I have seen a muscular fasciculus, as it ap- 
peared from the nuclei it contained, crossing the sphincter at right angles for 
a short distance ; this observation, so far as it goes, seems to imply that the 
same mode of insertion of the dilator occurs in man as in the horse. 

The fibre-cells of the dilator appear to be held together much more closely 
than those of the sphincter, at least in the outer part of the iris; for I have 
never been able to define the individual fibre-cells in a perfectly satisfactory 
manner in the dilator, though I have often teased out portions of the outer part 
of the iris. The dilating muscular tissue is also probably less abundant than 
the muscular tissue of the sphincter ; and this, if the fact, will help to account 
for the comparative difficulty in discovering it. I may here mention that both 
in the cat and in the rabbit, soon after death, dilatation of the pupils being 
present, exposure of one iris to the air caused it to contract at once, while the 
pupil continued dilated in the other eye, which was untouched. I do not know 
if this fact has been observed before, but it is interesting in two ways : first, as 
showing that the muscular tissue of the iris, like other muscular tissue, is 
obedient to the stimulus of exposure ; and, second, as proving either that the 
sphincter is in these animals a decidedly more powerful muscle than the dila- 
tor, which is equally exposed to the stimulus ; or else that the fibres of these 
two muscles have different endowments, as has been shown by Mr. Wharton 
Jones to be the case with the muscular tissue of the arteries and veins of the 
bat's wing; where, although the veins are muscular, and even contract rhyth- 
mically, yet the arteries alone exhibit tonic contraction when irritated by me- 
chanical stimulus. 

A rich network of extremely fine fibres, seen readily in the flat human iris 
viewed from the anterior aspect, appears to represent the nerves of the organ. 
The fibres are of a yellowish colour, and are possessed of pretty high refractive 
power ; they present, if really nervous, a good illustration of the division and 
anastomosis of ultimate nerve-fibres; the smallest divisions visible under a 
high power are seen only as fine lines. 

I have not seen any nerves in the human iris presenting the double contour ; 
but in the iris of a cat, so fresh that the tissue contracted under the needles as 
I teased it out, the double contour of the nerve-tubes was already very strongly 



1853.] 



Ophthalmology. 



243 



marked, showing the existence in this animal of the -white substance of Schwann 
in these nerves. The double contour surrounded the ends of the nerve-fibres 
which I supposed to have been broken by the teasing process. This last fact 
seemed to confirm the general belief that the double contour is a post-mortem 
effect, which, however, was in this instance a very rapid one. 

I believe that a further investigation of the fresh blue iris in man, and of the 
horse's iris, would supply the means of finally settling the question of the dis- 
tribution of the dilator pupillae. 

My engagements do not allow me to carry the inquiry further at present ; 
and my apology for offering the results of an incomplete investigation is, that 
a contribution tending, in however small a degree, to extend our acquaintance 
with so important an organ as the eye, or to verify observations that may be 
thought doubtful, may probably be of interest to the physiologist. 

56. A New Method for the more exact Examination of the Eye. By Dr. John - 
Czermak. {YierteljalirscliriftfurpraktischeHeilkunde. Prague. Vol. IV. 1851.) 
— The internal portions of the eye appear altered in shape, distorted, and re- 
moved from their proper relative position, in consequence of the rays of light 
reflected from these parts passing from the denser medium of the aqueous 
humour of the eye into the air, and suffering refraction, which is further 
increased at the spherical surface of the cornea; throwing out of consideration 
the difference of refracting power between the aqueous humour and the ma- 
terial of which the cornea is constructed. The result of these influences is that 
the anterior chamber of the eye loses its depth, and we receive no profile of a 
most important space in the human eye, the seat of many serious affections, in 
consequence of the iris being projected forward upon the cornea, and the inter- 
vening space obliterated. 

It is thus evident that we receive wrong impressions of the physiology and 
pathology of the eye, while the importance of the subject requires that our best 
exertions should be directed to the removal of these sources of imperfect and 
erroneous knowledge. 

The great distortion of parts composing the eye takes place at the surface of 
the cornea, and is due to its spherical shape. This difficulty it is in our power 
to obviate by the use of an instrument about to be described. 

Could we bring in contact with the eye any fluid of the same refracting power 
as the aqueous humour, and at the same time give to that fluid a plain surface, 
we should remove the great source of error in the investigation of the eye in get- 
ting rid of the convexity of the cornea. A fluid adapted to our purpose is for- 
tunately at hand, of nearly identical properties in regard to its refracting 
power, the index of refraction for water being 1.3358, while that of the cornea 
and aqueous humour is respectively 1.33 and 1.338. 

For this purpose, an instrument has been devised by Czermak. It is con- 
structed of four plane surfaces, forming the bottom and three sides of a box. 
The bottom of this box is made of lead, having a nasal external and anterior 
margin at right angles, while the fourth or posterior margin is cut in such a 
manner as to fit closely against the lower margin of the orbit of the eye, im- 
mediately under the lower lid, in a horizontal direction; the nasal side of the 
box is erected upon the bottom at right angles, being also of lead, and having 
three margins at right angles, while the posterior is convex, and intended 
to fit into the internal angle of the orbit close against the nose, filling up the 
orbit of the eye as high as the brow; these described parts being of lead are 
rendered of a deep black, it having been found, upon experiment with the 
instrument, that the eye was projected in better relief upon a black ground 
than upon glass, of which these parts were orginally formed. The external 
side is of plate glass, and long enough to project posteriorly beyond the ex- 
ternal angle of the eye, being pressed closely against the temple. The anterior 
or third side is also of glass, while the fourth side is formed by the orbit of the 
eye, against which the instrument is firmly held by means of a ring projecting 
from the under plate. The sides rise sufiiciently high to allow the entire eye to 
be inclosed in a water-bath, rendered tight, on the side of the instrument next 
to the eye, by the close adjustment of its margin against the soft parts sur- 



244 



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[Jan. 



rounding the orbit. It will be seen that, for use, two instruments are required, 
one adapted for each eye. 

In making a practical application of this instrument, it is first accurately 
adjusted to its place, and then slowly filled with water, the eye being closed 
during this process, and continued so sufficiently long to accustom it to the 
novelty of its position. After a few moments have elapsed, the eye is slowly 
unclosed and yielded to our inspection, when a great change from the ordinary 
aspect of the eye will be observed. The iris will be seen to have receded, and 
to hang like a curtain suspended across the posterior part of the eye, while the 
cornea, in a like proportion, will have advanced, leaving thus an extensive an- 
terior chamber open to our inspection, where before all was confusion, the parts 
having been distorted and blended together by the refraction previously exist- 
ing at the spherical surface of the cornea. This refraction from the surface of 
a sphere having been removed, and a plane surface substituted in the glass 
plates of the instrument, the profile of the eye is restored, and its parts laid 
open for inspection in very nearly their true proportions. To persons unac- 
customed to the contact of water with the eye considerable annoyance was at 
first experienced in the process of examination; this difficulty was, however, 
removed by Dr. Hasner and Professor Arlt, at their clinics at the Hospital of 
Prague, by the admixture of a small proportion of the white of egg with the 
water previously in use. 

Let us now glance at the effect of this instrument upon the function of sight 
in the individual upon whom it is used. Under ordinary circumstances, the 
rays of light from the air are refracted at the surface of the cornea towards the 
axis of vision, this representing the perpendicular at this point, and the 
aqueous humour being the denser medium. The rays that have been here re- 
fracted are now collected by the lens, and a perfect image is formed upon the 
retina. Let the instrument be adjusted to the eye, and an object be placed 
within it, upon which the eye of the person to whom the instrument has been 
applied shall be directed. The eye and object being now in almost the same 
medium, the aqueous humour and water having a nearly identical refractive 
power, there is no refraction at the surface of the cornea, and the lens does not 
succeed in collecting the rays and forming a focus until the retina has been 
passed, consequently there is no distinct vision. In Gehler's Physical Dictionary, 
vol. iv., second part, p. 1384, the following formula is given of the loss of re- 
fraction experienced by the eye when under water, furnishing us with the 
mathematical measure of vision under the conditions just proposed. The 
index of refraction from air into the aqueous humour — n : 1 = 1.337 from water 
into the same — w:l== 1.00075. Assuming the semi-diameter of the cornea at 
= <7 = 3" / .75, the distance of the object from the eye =-d = 10 / (the above 
measures being French), the distance of the focus behind the lens —f, we have 

f = 7 — =16 /// 3982 : now substituting w for n it gives f ; = W % 

J (n-l)d-g ' m ° m S J \w-l)al~g 

= — 123 /// ,043, which is that rays coming from a distance of ten inches are not 
united into a focus by the influence of refraction ; but are only so united when 
they shall have come from a distance of 10 inches and 3 lines. It is thus evi- 
dent that the eye under water becomes very far-sighted in consequence of the 
refraction of the cornea and aqueous humour, which together may be taken as 
a lens of 16 /7 .3982, focal distance having been lost. Near-sighted persons, 
consequently, when under water see well ; and it is estimated, that for a perfect 
eye to enjoy vision under the above circumstances, a bi-convex lens of 4.6 lines 
diameter, made from a substance of 1.55 refracting power, would be required. 

It will be borne in mind that the conditions treated above required the eye, 
and also the object on which the eye was directed, to be within the water; there- 
fore, the above deductions do not apply in the use of the instrument which we 
are describing. The spherical refraction of the cornea having been removed 
by the substitution of a glass plate, forming the front of the instrument, there 
remains only the small amount of refraction experienced at the surface of the 
glass, and that caused by the water within the instrument, while the ray is 
passing the contained space between the anterior plate and the eye. Although 
the rays, proceeding from the parts within the eye undergoing inspection to the 



1853.] 



Ophthalmology. 



245 



eye of the beholder, suffer a refraction in passing the water, as well as at the 
plate glass of the instrument, it is to be remembered that the distortion of parts 
occurs from spherical refraction at the surface of the cornea, and that the refrac- 
tion of the plate glass may be entirely avoided by inspecting the eye from above, 
where the instrument is uncovered and water alone interposed. 

Dr. Hasner, one of the editors of the Journal of Practical Medicine, in which 
the publication of Dr. Czermak describing his instrument is found, has written 
an article, entitled "Consideration of some of the Aids to Ophthalmoskopie," 
and states as follows: — 

The great advantage derived from the use of the orthoscope (this name being 
given to Czermak's instrument) is the complete removal of the mirage produced 
at the surface of the cornea, permitting us to inspect the visible portions of the 
eye — the iris, cornea, anterior chamber, and lens, in their true position and 
just proportions. In a word, we are furnished, by this instrument, with a com- 
plete profile view of 'the anterior chamber, permitted to estimate the exact distance 
between the cornea and iris, and between the iris and lens, and thus conclude 
upon the nature and extent of pathological deposits. I have found the ortho- 
scope of essential importance in the following cases, and have found my diag- 
nosis materially assisted and improved in hypertrophy of the iris or cornea, 
and particularly the former. When an operation is admissible for a new pupil, 
I have been rendered confident by the complete knowledge of the extent of the 
injury, and been enabled to operate promptly and with decision. In hernia of 
the iris, or adhesions to the capsule of the lens, and contraction of the pupil; 
in prolapsus of the iris, after operations for cataract, or loss of the crystalline 
lens, or in exudations upon or into any of these structures; occlusions of the 
lens, or cataract pyramidalis, the seat and extent of these lesions are placed 
beyond doubt, as well as all nebula, fixed and determined in regard to their 
position and extent, by the orthoscope. In my wards, at the Hospital of 
Prague, there is a woman with the results of hydataditis, in whose eyes, by 
means of the orthoscope, I am enabled to see points of exudation from the 
posterior surface of the cornea, extending into the anterior chamber of the 
eye as clear yellow nodes. These are entirely invisible by any other means in 
my possession than the orthoscope. 

Having mentioned the advantages to be derived from the employment of this 
instrument, it is only just that we should enumerate the difficulties which, in 
our hands, have attended its use, for the double purpose of calling the atten- 
tion of those persons to its defects who may be interested in having a perfect 
instrument, and guarding it against the accusation of those who, insensible to 
its real merits, might reject it, having found that it failed to meet the perfec- 
tion prescribed for it in their imagination. The orthoscope is not entirely free 
from refraction, and therefore does not give the exact proportions of the eye 
mathematically considered, and is not expected to drive out of use the magni- 
fying glass, and natural unaided eye, as adjuncts in the formation of a diag- 
nosis. The objection made to the contact of water with the eye, I have suc- 
ceeded in obviating by using water at the temperature of 90° Fahr. ; but have 
always found great care required to prevent the patient from becoming wet 
upon the slightest motion, when the instrument was filled with water. To pre- 
vent this, it has been proposed to make the sides concave. Again, care must 
be taken, in the application of this instrument, that too much pressure be not 
made upon the soft parts around the orbit of the eye, producing ecchymosis, 
in our efforts to make the adjustment so perfect as to prevent the escape of 
water and the consequent annoyance of the patient. C. W. 

57. Mr. Bowman's New Operation for the Division and Removal of False Mem- 
brane or Opaque Capsule from the Axis of Vision. — This method consists in the 
use of two ordinary cataract needles simultaneously. They are introduced 
through different points in the cornea down to the band of membrane, and their 
points having entered it at the same or neighbouring situations, as convenient, 
are then separated, tearing it across, and carrying it in two fragments to oppo- 
site sides of the pupil. Thus there is no drag put upon the vascular parts, and 
the only tissues touched are the cornea and the opaque membrane itself. One 



246 



Progress of the Medical Sciences. 



[Jan. 



needle may be made to furnish a fixed point of resistance from which the other 
can act with advantage. During the last ten days, this method of operating 
has been successfully adopted in seven instances ; three of them were cases in 
which, after the removal of the lens by drilling, the pupil still continued closed 
by false membrane; and, in the other four, the sight was more or less interfered 
with by bands of lymph or tough opaque capsule passing across the axis of 
vision behind the iris. 

We have selected the following case by way of illustration: "William Hen- 
derail, aged 28, a soldier, was admitted as an out-patient, August 3, 1852, being 
totally blind from the effects of syphilitic iritis. In each eye the pupil was 
rather less than medium size, irregular, and completely occluded by opaque, 
whitish, false membrane. He stated that, two years previously, he had, in 
conjunction with other syphilitic symptoms, suffered a very severe attack of 
inflammation of his eyes, for which he was six months under care in a military 
hospital. When discharged, he was much in his present condition, and had 
ever since been quite blind. 

Mr. Bowman performed, on the right eye, the operation of drilling, which, 
after a month had elapsed, was repeated. 

On October 15, there was a small open point in the centre of the opacity, 
which was perfectly black, and through which he had perception of light, and 
could distinguish large objects. In the hope of still further improving his sight, it 
was determined to attempt to get rid of a larger portion of the opaque membrane. 
Two cataract needles were accordingly introduced into the eye from the opposite 
sides of the cornea, and passed down in such a direction that their points met 
in the centre of the false membrane. On separating them, the latter at once 
tore vertically down, and its two halves, being carried one to each side, were 
lost behind the iris, leaving the pupil perfectly clear. 

October 23. The inflammation which followed the operation has been but very 
slight, and affecting only the conjunctiva. The man has now an oval pupil of 
fair size, quite clear, and black. He can see with tolerable distinctness, and 
his sight is daily improving. Mr. Bowman intends before long to perform a 
similar operation on the other eye. — Med. Times and Gaz. Oct. 30, 1852. 

[We believe that if Mr. Bowman will use a straight needle, properly con- 
structed, and with a long cutting edge, he will be able to accomplish with one 
needle all that he has effected in the above eases with two, and subject the 
patient to only half the risk of injury to the eye.] 

58. Amaurosis from Concussion. Treatment by Mercury. Recovery. — The 
following case of this is reported in the Med. Times and Gaz. (Sept. 4, 1852) : — 
A man, 28 years of age, florid and robust, who had a week before received a 
very severe blow over the left eye from a cricket-ball, was admitted into St. 
Bartholomew's Hospital, under Mr. Wormald, July 26, 1852. He was knocked 
down and much stunned at the time, and, on recovering his consciousness, was 
very sick. On opening the eye, no change in its structure was apparent, but 
it was totally blind. The parts above and below the orbit were lacerated and 
much bruised, and for several days the swelling was such as to preclude the 
further examination of the eye. When able to do so, however, he found that 
the loss of vision still continued. At the time of admission, the surrounding 
tumefaction had nearly subsided, the conjunctiva and sclerotic were much con- 
gested, the pupil dilated to its utmost extent, and perfectly motionless. When 
the sound eye was closed, he could but just distinguish light from darkness. 

R. Hydr. chlorid. gr. ii, pulv. opii gr. ter die sumend. Milk diet. 

July 31. He can see much better with the injured eye than before ; the pupil 
is rather less dilated, but still quite motionless. That of the sound eye can be 
made to contract by suddenly admitting light to the other. He has no pain in 
the part, or headache. 

August 1. Ptyalism. His vision is better than yesterday, but he has severe 
diarrhoea, with colic. 

To suspend the pills and take pulv. aromat. 9j ter die. 

2d. The pupil of the left eye is much less dilated, but still all but motionless. 
He can see with tolerable distinctness. 



1853.] 



Midwifery. 



247 



5th. He can now read large print, and, excepting a slight appearance of mist 
which surrounds all objects, his sight is as good as formerly. The left pupil 
now contracts sluggishly when stimulated, but it is still somewhat larger than 
that of the sound eye. The congestion of the tunics has disappeared. 

He is discharged. 

All who have had much experience in ophthalmic diseases will be aware that 
it is very common for cases similar to the above to terminate in permanent 
blindness of the injured eye. In this instance, the man, in all probability, 
owes the restoration of his sight to the treatment adopted, and another case is 
afforded in support of the practical rule, that, when blindness or impaired vision 
result from concussion of the eyeball, the rapid and free exhibition of mercury 
should never be neglected. 



MIDWIFERY. 

59. Case of Arm-Presentation successfully conducted without Turning. — It has 
been an axiom in obstetrics to turn in every case of arm-presentation where 
turning is practicable. Dr. R. G. Mat.ne records (Lond. Journ. Med. Oct. 1852) 
the following case in which he departed from this rule, and with a happy re- 
sult. 

" On the 20th June, 1852, I was summoned to attend Mrs. H. on occasion of 
her first accouchement, and reached her house at six o'clock A. M. She was 
of sallow complexion, a small, lean figure, and thirty-six years of age. She 
had had pretty smart pains since four o'clock P. M., of the previous day, and 
the membranes had given way, with considerable discharge of the waters, an 
hour before my coming. I found her walking about her bedroom, her progress 
arrested every now and then by regular and evidently powerful uterine con- 
tractions. After a little while spent in persuading her to submit to examina- 
tion, I ascertained that the os uteri was dilated to the extent of a half-crown 
piece, and that the case was one of arm-presentation, my finger-point at once 
encountering several objects, which gradually became distinguishable into the 
fingers of a minute left hand, resting in close contact with the acromial portion 
of the shoulder of the same side, and the broad surface of the corresponding 
scapula. The occiput, and the back of the child, were thus directed to the 
abdomen of the mother; its head above, or resting upon her right ilium, as she 
lay, in the usual posture, on her left side. 

"The discovery was far from agreeable, having particular duties to attend to 
for the day, which the nature of the presentation, the stature, aspect, and age 
of Mrs. H. allowed little expectation of my being able to perform. The pains 
continuing vigorously recurrent, I did what I could to promote dilatation by 
repeatedly passing the finger, with some slight degree of pressure, round and 
within the tense rim of the os uteri, during the contractions. By seven o'clock 
A. M. such progress had been made, that the child's hand and greater portion 
of the forearm had entered into the vagina, the upper, or humeral portion, and 
arm proper itself, being detained by the cincture, formed by the cervix uteri, 
binding down and hindering the passage of the elbow. 

" In accordance with early precept and past practice, I contemplated the ope- 
ration of turning as the orthodox expedient to be adopted, and commenced by 
introducing the fingers and thumb of my left hanfl, conicaily packed together, 
into the vagina, which, from the rigidity of parts, would admit no more, even 
after some perseverance. I persisted in trying to urge my way, though every 
movement — even of a finger-joint — provoked a more energetic resistance. I 
also made some attempts to push the child's hand and arm up into the womb, 
with the view of securing greater facility in preparing for the contemplated 
operation of turning; but each expulsive effort sent them forth again as before. 
Could nothing be done to alter this state of things ? This question presented 
itself over and over again, as with all my efforts I could make no progress 
towards foot-version; and I resolved to try. 

" The idea of the practicability of returning the arm, and of exerting a repress- 



248 



Progress of the Medical Sciences. 



[Jan. 



ing force upon a part of the presentation, according to circumstances, so as to 
convert the case into one of natural labour, had formerly occurred to my mind 
when engaged on one or two similar occasions, and I had then endeavoured to 
act upon it, but found, to my disappointment, that matters resumed their faulty 
condition so soon as such endeavours ceased. In those cases, however, the 
protrusion of the hand and arm was much more complete, when I was first called 
to them, and had existed for a longer period, than in the present instance. 
Here, there were circumstances of one kind which seemed favourable to the 
prosecution of the idea ; thus, the presentation had but partially entered or 
dipped into the cavity of the pelvis, and, as yet, the hand and part of the fore- 
arm only had escaped beyond the constricting band of the cervix uteri. But 
there were also others, as the discharge of the liquor amnii about two hours 
before, the patient being a primipara, her constitution and age, which inclined 
to the reverse. The latter considerations, however, were equally inauspicious 
as to any facility to be hoped for in performing the operation of turning; and, 
therefore, with my hand firmly wedged in the vagina the while, I, after repeated 
though hasty and anxious deliberation on all these points, decided on the pro- 
priety of making a persevering effort to alter the character of the presentation. 

"Having quite failed in carrying my hand beyond the second joints of the 
fingers and thumb, every endeavour to do so causing painful and loudly com- 
plained of increase of the contractions, I extricated my thumb altogether from 
its confinement, by which the fingers were now enabled to pass in a flattened 
form of the metacarpus, as far into the passages as the junction of the thumb 
with the fingers at its first joint would permit. By this means, I pushed the 
child's hand and arm (in reference to the position of the mother) back, or (in 
relation to the erect posture) up towards the fore part of the body of the womb, 
till they rested above the pubic portion of the pelvis, to which point my own 
fingers also reached, and steadily retained them there, by uninterruptedly bear- 
ing upon the latter, or rather upon the arm proper, a little above the elbow, for 
one hour and a quarter. During this space, the pains, which were uncompro- 
misingly withstood, so far as they could affect the arm and parts against which 
it was urged, regularly recurred, and slowly advanced the labour, so that the 
descending presentation began to press uncomfortably on my already cramped 
fingers. 

"The woman had for some time complained of my pushing back the child at 
every pain ; and, in no gentle tones, now ordered me to desist altogether, at 
least for a time. Her friends, impressed with some alarm by her vociferations, 
added their remonstrances to the same effect. Therefore, having carried out 
my intention as far as was possible, I withdrew my hand, resolved to abide the 
issue, without any further active interference. Leaving her to herself for a 
short time, in which several pains occurred, I was much gratified and encou- 
raged, upon a digital examination, in finding that the arm had not again de- 
scended, and that the labour was making perceptible progress. Deriving relief 
and confidence from these two facts, yet conceiving that whatever course the 
case should take, I might now safely leave for an hour, in order to fit myself 
for the day's engagements, I retired at half-past eight A. M. 

'■'At half-past nine A. M. I again saw my patient, and really felt overjoyed to 
find a perfectly natural presentation. At ten minutes past ten A. M. I deliv- 
ered her of a well-formed male child at the full time, with only a slight swelling 
of the left hand and forearm, who is yet alive, if not to tell the tale, at least to 
afford evidence of the practicability of acting successfully upon my idea. The 
mother, in common parlance,- had not a bad symptom; and is now in her ac- 
customed health/'' 

CO. Supposed Extra-Uterine Abdominal Pregnancy ; Natural Delivery. — It is 
ever wise not to be hasty about operating, and especially not to have recourse 
to the Caesarian section before it is clearly shown that the patient must sink if 
this formidable operation be not performed. Here is a case which gives this 
rule a world of strength. 

A woman, twenty-nine years of age, was admitted on the 18th of April, 1852, 
into the IIGpital Beaujon, at Paris, under the care of M. Huguier. The prac- 



1853.] 



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249 



titioner who sent her considered that she was affected with hydatid cyst of the 
liver. M. Huguier, who never attempts the diagnosis of abdominai tumours 
without inspecting the genital organs, was struck by the purple colour of the 
vulva and the vagina, and asked the patient whether she were not pregnant. 
Being a widow, she at first denied it ; but after a little pressing, it turned out 
that five or six months previously she had been ill-used by strangers. 

Although the colour of the vagina pointed to pregnancy, the other symptoms 
of gestation were certainly of a strange and obscure character. The abdominal 
tumour was situated exactly under the hepatic region, more prominent to- 
wards the umbilicus than in the vicinity of the groin, and so high up indeed 
that the hand pressing upon the abdomen reached the promontory of the sacrum 
easily. The body of the uterus could not be made out by the finger passed into 
the vagina ; but the os tincse might be felt on the left side far above the pubes. 
On the right side, however, and posteriorly to the vagina, an angular body was 
protruding, which felt like an elbow or a heel, and this was still more palpable 
through the rectum. Some movements were detected in the body of the child, 
which was seemingly lying in the right hypochondrium, and the sounds of the 
foetal heart were plainly heard. 

M. Huguier communicated the case to the Surgical Society of Paris, asking 
his professional brethren to see the patient, and to give their opinion on the 
propriety of operative interference. A committee was appointed, and M. Daii- 
yau reported upon the case. The committee were unanimous as to the exist- 
ence of extra-uterine gestation, but thought that no operation should be 
attempted until labour had commenced. Subsequently, however, some doubts 
arose in M. Danyau's mind, and he examined the patient again with Professor 
Dubois. The latter considered that the very absence of the cervix, which had 
led to a suspicion of abdominal gestation, made him think that the pregnancy 
was quite normal, but that the body of the child had perhaps lodged in the 
posterior portion of the uterus, as it has been known to happen with the ante- 
rior part, so that a limb of the child might be tilted forwards, and be retained 
in a kind of cul-de-sac. 

It was, therefore, again resolved that the pains of labour should be waited 
for ; and these having begun on the 1st of July, M. Huguier sent for some of 
his colleagues, and especially for M. Roux and M. Danyau. These gentlemen 
met, and preparations were made for the operation ; but before transferring the 
patient to the operating theatre, M. Roux made a vaginal examination, and 
stated that he felt something very much like a head. The presence of this por- 
tion of the child was soon ascertained by the other surgeons ; the pains became 
very strong, and in one hour the woman was delivered of a child which lived 
only two hours. A vaginal examination was made the next day ; but the body 
of the uterus was not found any more than before delivery, and the cervix was 
as high as it had been found on former occasions. These circumstances led 
M. Huguier to suppose that the shape of the uterus must be of a very unusual 
kind.— Lancet, Nov. 20, 1852. 

61. Induction of Premature Labour by the MetJiod of Professor Kiiuisch. — Dr. 
Tyler Smith records [Lancet, Oct. 2) a case of deformed pelvis, in which he 
successfully induced premature labour by the process of Professor Kiwisch, of 
Wurzburg. This method, Dr. Smith says, is devoid of many of the disadvan- 
tages and of all the dangers of previous operations. It consists in directing a 
stream of water from a height, by means of a syphon, continuously upon the os 
uteri. Kiwisch recommends the use of warm water; but Dr. Smith knowing, 
from experience in cases of hemorrhage, the increased efficacy of the alterna- 
tion of hot and cold temperatures in causing uterine contraction, he determined 
to try the effect of alternating the hot and cold douche. Accordingly, at 9|- 
A.M., September 1, a piece of India-rubber tubing, about eleven feet long and 
half an inch in diameter, was connected with a straight tube from an injecting 
apparatus, five or six inches in length, the latter forming the uterine extremity 
of the syphon. A vessel containing two gallons of water, of about 110° Fahr., 
was placed nine or ten feet from the ground, the patient being placed in an 
empty hip-bath. The proper end of the tube was now passed into the vagina, 



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[Jan. 



and directed towards the os uteri, where it was held steadily. After exhausting 
the tube, the other extremity was placed in the warm water. The stream im- 
mediately began to flow with considerable force against the os uteri, and con- 
tinued until the whole contents of the vessel had been discharged. Two gallons 
of cold water were then poured into the vessel, and discharged in the same man- 
ner. The time occupied by the whole douche was from twenty minutes to half 
an hour, the patient only complaining of discomfort when the hot and cold 
currents first began to run. During the after part of the day she complained 
of dysuria and occasional pains in her back. 

Sept. 2d. — One P. M. The douche was again applied in the same manner and 
quantity. 

She had labour-pains from half-past twelve until four. At nine o'clock, the 
douche was repeated. Two o'clock P. M. : Has had irregular uterine pain since 
the douche in the morning. On examination, the os uteri was felt dilated to 
the extent of half a crown. Douche repeated. Nine P.M.: Had considerable 
uterine pain for half an hour after douche. Douche repeated. 

4th. One A.M. Has had powerful uterine pains since last douche, and the 
child was born about half-past one A. M., or about sixty-four hours after first 
application of douche. 

" The time," Dr. Smith remarks, "between the first application of the douche 
in this case, and the completion of delivery, was less than frequently occurs in 
cases of puncture of the membranes. But it has been objected to the douche, 
by those who have used it on the Continent, that some women are less suscept- 
ible of its influence than others, and that the susceptibility of the same woman 
varies in different pregnancies. I suspect this variation may be obviated by 
performing the operation, when the time can be selected, at the eighth or ninth 
catamenial date, and by increasing the energy of the douche by the alternation 
of temperature." 

62. Induction of Abortion in the Vomiting of Pregnant Women. By MM. 
Dubois and Stoltz. — During a recent discussion at the Academie de Medecine, 
M. P. Dubois stated the results of his experience in relation to obstinate vomit- 
ing in pregnancy. In proof that this is oftener a more dangerous occurrence 
than is usually supposed, he stated that, in the course of thirteen years, he had 
met with twenty cases in which it has proved fatal. That obstinate vomiting 
is but the exaggeration of the natural sympathetic vomiting of pregnancy, and 
not clue to any special lesion, is proved by the facts that at the autopsies no- 
thing is found, and that when the process of gestation becomes arrested, whe- 
ther spontaneously or artificially, the vomiting is ordinarily put an end to, 
although the woman may not be delivered until several days after, of a dead 
child, and may yet die of the effects of what she has already undergone. M. 
Dubois refers to several cases in which the women, apparently at the point of 
death, were saved by the spontaneous death of the foetus, this being expelled 
only some time afterwards. In respect to the question of how far artifcial in- 
terference is attended with the same result, he furnishes notes of the four cases 
in which he has employed it. Three of these died and one recovered — this last 
being added to other cases on record, making the number of recoveries he is 
aware of certainly seven, and probably nine. In all the cases, however, whe- 
ther fortunate or not, the vomiting was suspended by the operation. The dif- 
ficulty is, indeed, to fix the period at which this should be resorted to; for it is 
the natural desire to delay this as long as possible, which leads to the fatal 
result — the woman dying, in fact, from the exhaustion and prolonged absti- 
nence which the vomiting has induced, prior to the operation for arresting it 
being undertaken. M. Dubois lays it down as a rule, never to perform it when 
the signs of extreme exhaustion are present, as evidenced by considerable loss 
of vision, cephalalgia, comatose somnolence, and disorder of the intellectual 
faculties. On the other hand, we should also abstain from operating when the 
vomiting, though violent and frequent, still allows of some aliment being re- 
tained ; when the patient, though wasted and feeble, is not obliged to keep her 
bed; when the suffering has not yet induced intense and continuous febrile 
action; and when other means still remain untried. In the first case, we 



1853.] 



Midwifery. 



251 



should not save our patient, but perhaps accelerate her death, and bring dis- 
credit on the operation ; while, in the other, we should sacrifice a pregnancy 
that might have gone on to the full time. It is, therefore, the intermediate 
period that should be chosen, and this is characterized by the following signs: 
1. Almost incessant vomiting, by which all alimentary substances, and some- 
times the smallest drop of water, are rejected. 2. Wasting and debility, which 
condemn the patient to absolute rest. 3. Syncope, brought on by the least 
movement, or mental emotion. 4. A marked change in the features. 5. Se- 
vere and continuous febrile action. 6. An excessive and penetrating acidity 
of the breath. 7. The failure of all other means. But even within this period, 
which is of variable duration, the opportune moment must be chosen. This 
seems to have arrived, when the inefficacy of the most approved treatment has 
been proved, when fever is found to persist, and the debility and wasting of 
the patient are making sensible progress. The attendant should now declare 
that the operation is indicated, leaving to the patient and her friends the duty 
of deciding upon its adoption. 

Professor Stoltz, of Strasburg, has published a highly interesting commu- 
nication upon this subject, in which he also states his belief that vomiting 
during pregnancy is much oftener fatal than is usually supposed. He relates 
four cases, from among others, that have come under his own notice. In three 
of these death occurred, and life was saved by the operation in the fourth, 
although the case seemed hopeless. M. Stoltz lays great stress upon the ope- 
ration being performed in good time, because, if we wait until the effects of the 
sympathetic reaction constitute in themselves a serious disease, the evacuation 
of the womb does not induce a cessation of these, and may, in certain cases, 
even hasten death — life, so to say, hanging upon a thread. It is undoubtedly 
difficult to say, when the moment has arrived that we can no longer hope for 
benefit from nature or therapeutical agents, But may not the same observa- 
tion be made with regard to many important surgical operations? It is true, 
that neither spontaneous nor artificial abortion always saves life in these cases ; 
but the former usually occurs only when the woman's powers are hopelessly 
exhausted, and the pain and discharge consequent on the delivery may expe- 
dite her end — the same result not being infrequently seen in severe fever. 
Some practitioners have expressed themselves very feelingly against sacrificing 
the child in these cases ; but there is a great inconsistency on the part of those 
who do so, and who still advocate the operation in the case of narrow pelvis. 
A woman who has undergone artificial abortion for obstinate vomiting, may 
hereafter (and these cases mostly occur in primiparse) give birth to a living 
child, which can never be the case in one who has so narrow a pelvis as to call 
for the induction of abortion rather than of premature labour. — Brit, and For. 
Med.-Chirurg. Review, Oct. 1852, from Gazette Medicate de Paris, No. 23. 

63. Stethoscopic Sign of Separation of the Placenta. — In our number for July, 
1852, p. 263, we noticed a supposed stethoscopic indication of the separation of 
the placenta pointed out by M. Caillant. Prof. Simpson, of Edinburgh, in a com- 
munication to the Edinburgh Obstetrical Society (Jan. 14, 1852), gave various 
reasons for dissenting altogether from the explanation of the sound offered by 
M. Caillant. Dr. Simpson believes the sound is produced by the mere physical 
compression of the placenta, as it is being expelled from the uterus ; and it 
could be imitated with a placenta, after its expulsion from the body, by press- 
ing the placenta through an aperture such as that of the cervix uteri. — Monthly 
Journ. Med. Sci. August, 1852. 

64. On unavoidable Uterine Hemorrhage. — M. Depaul read an elaborate paper 
upon this subject at the Academie de Medecine, in which he defended at great 
length the views held by MM. Stoltz and Dubois, upon the tardy development 
of the lower segment of the uterus. Our space admits only of the notice of some 
of the more practical parts of the paper. M. Depaul is of opinion that the 
attachment of the placenta to the lower segment of the uterus is of much 
greater frequency than those authors admit who have only noted the cases in 
which it has been found inserted over the orifice itself ; and he considers Lacha- 



252 



Progress of the Medical Sciences. 



[Jan. 



pelle's statement, that the majority of cases of uterine hemorrhage occurring 
after the sixth month are due to faulty insertion of the placenta, to be correct, 
when so understood. He does not regard the diagnosis of the occurrence by. 
the thickness and softness it imparts to the lower segment of the uterus, as 
beino; so easy as stated, when the cervix is long and closed. Nor is the absence 
of ballottement at all conclusive, as he has perceived it in several of these cases. 
He considers that the hemorrhage oftener shows itself in the course of the 
eighth or ninth month, than in the sixth or seventh, as stated by some. Even 
when the cervix is effaced, and the os opened, experienced persons have some- 
times mistaken coagula, or excrescences of the cervix, for the placenta. M. 
Depaui considers that the prognosis as regards the mother has been exaggerated, 
and that with due care the mortality, stated by Simpson at one-third, might be 
much diminished. It is more serious when the placenta is inserted over, in 
place of near, the orifice, and in the earlier period, when the cervix is hard and 
closed. He agrees with Lachapelle that more than half the children are lost, 
especially when it is considered that many of those born alive are so before 
their time, and exhausted by the disturbance of the placental communication. 

In the treatment of these cases, (1.) when the hemorrhage is slight, and the 
os closed, and no uterine contractions are present, he recommends the employ- 
ment of the usual general means to arrest hemorrhage, such as posture, opiates, 
acidulated drinks, &c, and small haemostatic doses of ergot. When (2.), with 
the same conditions of the uterus, the hemorrhage is great and increasing, 
besides the above means, he advises plugging the vagina. This may act by 
favouring the coagulation of the blood, and the obliteration of the vessels left 
open by the detachment of the placenta ; and by hastening the advent of labour 
and the dilatation of the orifice. This last end is not always attained ; for 
cases have occurred in which the plug has been applied for twenty-four or 
thirty-six hours, with the effect of arresting the hemorrhage without producing 
any modification in the cervix. When, in spite of the plug, the bleeding still 
continues, in part internally, and in part externally, and the woman appears 
in any danger, we should rupture the membranes ; and if such partial emptying 
of the uterus is not attended with prompt improvement, delivery should be 
forced, even if multiplied incisions of the cervix uteri are necessary for this 
purpose. When (3.) the hemorrhage is slight, and has commenced at the full 
period of pregnancy, or when repeated hemorrhages have induced premature 
labour — a certain degree of dilatation being present — if the loss is very mode- 
rate, we may order rest and other general measures, and give ergot to hasten 
the labour. When the dilatation has become considerable, we should rupture 
the membranes, especially if the hemorrhage, without being great, has been of 
long continuance or frequent repetition, so as to have materially damaged the 
health. The same course is justified in the interest of the child, the life of 
which will be risked by its prolonged detention in the uterus after a consider- 
able separation of the placenta. It is in this case that obstetric auscultation 
becomes so useful; and when this shows the child's life to be in danger, the for- 
ceps, or version, should be had recourse to, even when the dilatation is not so 
great as in other cases would be deemed desirable. When (4.) the os is more 
or less dilated, and the hemorrhage too serious to admit of temporizing, if the 
membranes are still intact, the dilatation not being quite complete, these should 
be ruptured, and the ergot given in preference to using aplug. M. Depaui has, how- 
ever, the greatest objection to perforate the placenta itself, at the risk of inflict- 
ing injury on some vessel that might prove fatal to the child. Even in central 
insertion, whenever possible, he detaches an edge of the organ to get at the 
membranes. In central insertion, too, he would employ the plug as a dilator. 
On account of the danger the child incurs, he likewise objects to Simpson's plan 
of prior detachment of the placenta. When, in spite of the discharge of the 
waters, the hemorrhage continues, or the child's life is found to be endangered, 
we must deliver; and, in these cases, the somewhat forcing delivery is prefer- 
able to the employment of the plug, lest even a moderate amount of uterine 
hemorrhage prove too much for the exhausted powers of the woman, or a too 
long delay prove fatal to the child. 

It is an error to suppose that the woman is always safe when delivery has 



1853.] 



Midwifery. 



253 



been accomplished; for she sometimes sinks from -subsequent hemorrhage. 
This occurrence is explained by the special vascular distribution at the lower 
segment of the uterus, and the less disposition this part has to contract. To 
secure due contraction, the ergot is the best means ; and perhaps it should 
always be given in these cases immediately after delivery. — Brit, and For. Med.- 
Chirurg. Review, Oct. 1852, from Bull, de V Academic, vol. xviii. pp. 849-874. 

65. On the Continuance of Lactation during the Progress of Diseases. — Dr. 
Eoser states that the results of his observation during thirty-two years, have 
quite convinced him that the routine practice of desiring mothers to discon- 
tinue suckling when they become the subjects of serious disease, is erroneous, 
the ill-eifects of the milk upon the infant having been ridiculously exaggerated. 
He has already called the attention of the profession to this matter, in an essay 
on typhus, published ten years since, and all subsequent experience has only 
confirmed him in his views. He objects to the cessation of suckling for any 
other cause than local inflammation of the breast, the resolution of which it 
may prevent, and the cessation of the secretion, which, however, is often due 
to the neglect in continuing to apply the child: and he cites cases in which the 
continuance of the child to the breast, in apparently hopeless affections, was 
attended by the best results. He remarks upon the inconsistency in arresting 
a secretion which is so powerful an agent in abstracting the proteine-compound 
from the blood, while, at the same time, by exciting other excretions, and em- 
ploying various antiphlogistics, we endeavour to diminish the fibrinous and 
albuminous elements of the fluid. The effect of suppressing pathological se- 
cretions in causing or aggravating disease is admitted, and yet we suppress a 
normal one, which is exerting an important derivative action on existing dis- 
ease, and has established the habit, on the part of the system, of requiring such 
a drain. In the various epidemics of typhus witnessed by Dr. Rbser, he has 
found the continuance of suckling, while the milk remains, of great service in 
the prevention of bronchitis and pneumonia, which are the usual causes of 
death; and in inflammatory diseases, he recommends the practice even when 
collapse has occurred. Even when a woman is suckling much beyond her 
time, the child should not be taken from her during an attack of inflammation. 

Dr. Rbser strongly objects to the advice so commonly given to women suffer- 
ing from, or threatened by tubercular disease, to abstain from suckling. He 
regards it as one of the best of preservatives, as also a means of prolonging 
life when cavities are formed; and he states that he is in possession of many 
cases justifying this opinion. Suckling, too, pursued within normal limits 
(which vary in different women, but average nine months), is always advan- 
tageous in pure neuroses, including hysteria itself. In the same way is the 
numerous class of affections benefited dependent on a stasis of the blood, and 
marked by chronic inflammatory action, and the generation of adventitious 
productions. — Brit, and For. Med.- Chirurg. Rev. Oct. 1852, from Froriep's Ta- 
gesberichte, &c. Nos. 444 and 446. 

66. Epidemic of Fueiperal Gangrenous Vulvitis. By M. Chavanne. — During 
the early part of the cold January of 1850, several of the puerperal women at 
the Charite of Lyons were attacked, three or four days after delivery, with 
vomiting and diarrhoea, or with febrile paroxysms and abdominal pains, or 
slight hemorrhage. These symptoms were followed, in twenty-six cases, by 
lassitude or prostration, and lowness of spirits, and by the development o*f 
cedematous redness of the vulva. In a few cases, the disease did not extend 
beyond this stage, active febrile symptoms becoming, however, developed; but 
in the great majority, pultaceous plates, resembling Delpech/s pulpous form of 
hospital gangrene, formed on the interior of the vulva and vagina, closely ad- 
hering to the mucous membrane. Although their extension became limited in 
a day or two, they were not separated by the inflammatory process until the 
end of the first week, or during the second ; small, superficial, suppurating 
wounds being left at the points they occupied, which usually soon healed up, 
though occasionally degenerating, and becoming covered with the same pulta- 
ceous mass. In four of the twenty-six cases, the disease extended to the uterus, 

No. XLIX.— Jan. 1853. 17 



254 



Progress of the Medical Sciences. 



[Jan. 



and the patients died, having presented all the symptoms of intense puerperal 
fever, the gangrenous condition of the uterus becoming complicated with peri- 
tonitis. No cause could be assigned for the development of the epidemic ; both 
the general sanitary conditions of the establishment, and the prior state of 
health of the patients, having been satisfactory. In twenty of the cases, the 
labour was natural, the forceps, however, having been applied eight times; and 
while the affection seized some of the patients who had very easy labours, 
others of the inmates, whose cases required active interference, entirely escaped. 
Besides the four cases above mentioned as having proved fatal, three others of 
the twenty-six died from metro-peritonitis, without extension of the gangrene. 
The other nineteen recovered, the gangrene usually soon yielding to tonic regi- 
men, and the local use of the strong muriatic acid. A very similar epidemic 
was observed at Lyons in 1815 ; and another of the same character has been 
recently witnessed in Paris. — Brit, and For. Med.-Chirurg. Review, Oct. 1852, 
from Gazette Medicale, No. 16. 



67. Infanticide, and what may be confounded with it. — The frontal and parietal 
bones are the only ones which Dr. Weber ( On the Strength of the Skull) has 
seen fissured and fractured by the act of parturition. According to the greater 
or less extent of the fracture, and particularly the distance of separation be- 
tween the edges of the injured bone, so is the amount of injury to the vessels 
of the locality of the fracture. Rupture of small ones always occurs, as is 
proved, by the most delicate fissure being indicated by a red streak. The peri- 
osteum is generally elevated by extravasated blood, and there are marks of 
suggillation from effusion into the cellular tissue of the scalp. In these cases, 
internal cephalhematoma may occur. But the extravasations here alluded to 
must be distinguished from those which follow rupture of the longitudinal 
sinus, and of the larger cerebral veins. It is true that both forms may be pre- 
sent ; but, according to Dr. Weber, the latter are not the consequences of the 
fracture, namely, " a too violent forcing of the bones over each other." Bednar, 
after referring to the fissures and fractures, dwelt on at some length by the 
former writer, remarks that " in the cranial bones of new-born children chinks 
are sometimes observed running from the surface for several lines deep into 
the bone, generally in a somewhat oblique direction. Their origin we cannot 
explain, as, from the yielding character of the bone, we are unable to produce 
them in the corpse by stroke or pressure." — British, and Foreign Medico- Chirurg. 



68. Whether a Blow on the Head, producing Fracture of the Skull, ever causes 
immediate Death. — Dr. Lente, in a communication on the Statistics of Fracture 
of the Cranium at the New York Hospital {New York Journal of Medicine), 
after analyzing 117 cases, of which 21 recovered and 96 died, remarks: "In 
no case did death follow the receipt of the injury, until after the lapse of some 
hours, even in the most desperate cases ; nor does it appear to be possible for 
an ordinary blow on the head, producing fracture of the skull, to cause imme- 
diate death. In a recent criminal trial of great interest, it will be recollected 
that at one stage of the proceedings it was much discussed whether a blow 
upon the head with an ordinary weapon capable of inflicting death could produce 
this result instantaneously. Many eminent surgeons were examined, and the 



Professor F. H. Hamilton, of Buffalo, in his table of Fractures of the Cra- 
nium, the cases amounting to 33, of which 21 recovered and 12 died, according 
to the reporter, arrives at a similar result. — Buffalo Medical Journal, September, 



MEDICAL JURISPRUDENCE AND TOXICOLOGY. 



Review, July, 1852. 



T. R. B. 




1852. 



T. R. B. 



1853.] 



Medical Jurisprudence and Toxicology. 



255 



69. Vomiting produced by the Application of Galvanism. — We read the an- 
nexed curious statement in the London News of the 25th September, 1852: — 

" In the case of a woman uamed Maning, brought up to the Marylebone Court 
from the infirmary of Marylebone, charged with having attempted to commit 
suicide by swallowing a quantity of bitter almond oil, it was stated that a new 
galvanic process had been used in aiding her recovery. 

" Mr. Broughton (the magistrate) asked in what way it acted. 1 Did it cause 
her to vomit?' 

"Mr. Mercer (relieving officer). 'It causes the stomach to resume its mus- 
cular action, when a patient vomits the ivhole of the poison. It is considered 
a more efficacious application than the stomach-pump. It was the first time it 
has been used at the infirmary.' 

" Mr. Broughton. 4 Is it a painful operation?' 

" Mr. Mercer. ' No sir; it produces a slight shock to the system.' 

" Mr. Broughton. 1 How long was it before the battery was applied, after her 
admission?' 

" Mr. Mercer. ' Immediately: when brought in, she was in a state of para- 
lysis ; and she would have died except for the prompt attention of the medical 
officers, who succeeded in restoring her to consciousness.' 

" The defendant stated that she had swallowed a six-penny (about 12 cents) 
worth of the poison, having been led to the act by domestic troubles." 

— T. R. B. 

70. On Suicide by Strangulation ivithout Suspension. By N. Jacquier. Paris 
& Troves, 1851: pp. 31. — This little pamphlet contains the history of eighteen 
cases of suicide by strangulation. The conclusions at which M. Jacquier ar- 
rives are: 1. That strangulation, whether voluntary or not, may be performed 
in three ways — by complete suspension, by incomplete suspension, and without 
suspension. Under these three circumstances, death is determined by apoplexy, 
by asphyxia, or by syncope ; frequently, by all these causes combined. 2. The 
possibility of suicide by strangulation without suspension is now generally ad- 
mitted, but is regarded as of rare occurrence, and consequently gives rise to 
suspicions of homicide. 3. The infrequency of this mode of suicide is not attri- 
butable to the difficulty of effecting it, but to the general belief of its difficulty. 
—Medical Times and Gazette, July 24, 1852. T. R. B. 

71. Camphor in Cases of Poisoning by Strychnine. — The following is adduced 
by Dr. Pidduck as a proof that camphor is an antidote. We are disposed as 
yet to doubt this; but are equally satisfied that it is a valuable remedy. — 

J. W., pianoforte-maker, a weakly man, of intemperate habits, accustomed 
to work in a hot workshop, and to exposure to cold to and from work, was the 
subject of severe attacks of rheumatic gout. After one of these, he was suffer- 
ing under dyspepsia, neuralgic pains, and general debility. For the relief of 
these symptoms strychnine was prescribed, in the dose of a sixteenth of a grain, 
three times a day. By mistake, at the chemist's, the grain of strychnine with 
sugar was divided into six instead of sixteen powders. 

The first dose, taken in the evening, produced severe twitchings of the 
muscles ; but the second dose, early in the morning, threw him into violent 
convulsions. The messenger who came said he was dying. Immediately, on 
discovering the mistake and witnessing one of the frightful paroxysms, Dr. 
Pidduck prescribed twenty grains of camphor in six ounces of almond mixture, 
one-fourth to be taken every two hours. The first dose so completely quieted 
the convulsions that there was no need of a second. — Lancet, July 24, 1852. 

T. R. B. 

72. On the Qualitative Separation of Arsenic, Tin, and Antimony. By George 
F. Ansell. — The method proposed by the author consists in dissolving the 
mixed sulphides in nitro-hydrochloric acid, and pouring the solution into an 
apparatus in which hydrogen gas is generated by the usual way. The evolved 
gases are first passed through a wash-bottle containing acetate of lead, to re- 
move any hydrochloric acid or sulphuretted hydrogen, and are then conveyed 
into a test-tube half filled with strong nitric acid. The nitric acid solution 



256 



Progress of the Medical Sciences. 



[Jan. 



obtained after the gases have passed for about a quarter of an hour, is evapo- 
rated to dryness, and the residue, which will contain the arsenic originally pre- 
sent, partly in the state of arsenic (acid?) and partly of arsenious acid, and the 
antimony in the state of antimonic acid, is exhausted with warm water, which 
takes up the first two and leaves the last-named substance. The tin remains 
in the vessel in which the hydrogen was generated. These are severally iden- 
tified by the application of the appropriate tests. — Pharmaceutical Journal, 
July, 1852. T. R. B. 

73. Remarkable Case of Suicide by Hanging. By F. C. Webb, London. — 
On the 18th of July, 1852, I was called, in conjunction with Mr. Roberts, to J. 
M., who was supposed to have committed suicide. We found him quite dead, 
the hands cold, and post-mortem ecchymosis commencing on the inner side of 
the thighs. He was lying supine along the foot of the bed, with his legs in a 
semi-flexed position. Above the pomum Adami was a dusky red line, about 
three quarters of an inch in width, which extended on each side, following the 
base of the jaw, and taking a somewhat curved direction from the angle of the 
maxilla towards the back of the mastoid process, above and behind which, on 
each side, it terminated. 

The body presented no other indications of injury, with the exception of a 
contused state of the integuments over the right eye and the right elbow. From 
the character of these bruises, we supposed them to have been received two or 
three days before, and they were accounted for by a fall which deceased had 
met with during the previous week. 

The examination of the body justified the belief that the man had died from 
hanging ; and from the absence of marks of violence about the hands and other 
parts of the body, it seemed probable that it was a case of suicide rather than 
homicide. 

Suspended from one of the posts of the bedstead was a leathern strap, 
which corresponded in width with the mark on the neck. This strap was passed 
over the upper end of the bedpost, and fastened to it at about ten inches below 
its top by being twisted and knotted round the pole. From the latter point it 
depended in a loop of one foot nine inches in length, whilst from the loop to 
the bedstead, on which deceased was lying, the measurement was one foot nine 
and a half inches. 

Evidence was given at the coroner's inquest that the deceased was found lying 
upon his abdomen on the bed, with his head in the loop, the face looking down- 
wards. He was quite dead when he was thus discovered. From the investi- 
gation, no doubt was entertained as to the case being one of suicide; the man 
had been intoxicated for three days previously to his death; and from other 
circumstances, the jury came to the conclusion that he was of unsound mind 
at the time of the occurrence. 

This case is peculiar, from the mode in which death was effected. It was not 
an ordinary case of hanging; the weight of the body was principally borne by 
the bedstead; the pressure of the head and upper part alone resting on the 
loop. The mode of fixing the ligature was remarkable, inasmuch as a large 
loop was employed instead of the noose, which has more frequently been found. 
Although it must doubtless have required a strong effort of the will to keep the 
head in a depending position until the supervention of asphyxia, yet a con- 
sideration of the insidious and rapid manner in which death takes place, the 
quickness with which insensibility comes on, and the few symptoms of which 
those persons were conscious who have been resuscitated, diminishes our sense 
of wonder at the determination of the unfortunate suicide. — Med. Times and 
Gaz. August 7, 1852. T. R. B. 

74. Poisonous Qualities of the Kernel of the Apricot. — At Aries, a child ate 
two or three apricots ; but, not content with this, also took the kernel inclosed 
in the nut. Very soon after he was seized with convulsions, and died in spite 
of every attention. 

These kernels have a peculiar flavour, which is ascribed to the presence of 
prussic acid. But until the present time, the quantity of it has been considered 



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so small that not the slightest danger has been apprehended from eating one or 
two. Whether the fatal result was in this particular instance owing to some- 
thing peculiar to the child, or to some morbid change in the fruit, cannot now 
be ascertained. But the true inference is to forbid the use of them, at least 
to children. — Gazette des Hopitaux, from the Journal de Chimie Medicate. 

T. K. B. 

75. Wounds and Injuries of the Bladder. — Solutions of continuity in the blad- 
der, from punctured and gunshot wounds, are almost invariably fatal by the 
supervention of peritonitis; but a considerable period sometimes elapses before 
the symptoms set in. The most common form of rupture of the bladder, how- 
ever, is from external violence, when the viscus is distended with urine. Such 
an accident is not necessarily fatal, as the readers of this journal are aware, 
from our report of Mr. Kynd's case, in a recent number; but as it almost always 
occurs where the serous membrane covers it, the issue is generally unfavour- 
able. Mr. Hird related an interesting case at the Medical Society of London, 
which is quoted by Mr. Coulson, to show that the patient may walk several 
miles after complete rupture, and for a time exhibit no symptom which attracts 
more than ordinary attention. Cases of spontaneous rupture from over-dis- 
tension are rather examples of sloughing than of anything else, the openings 
being generally numerous and small, and the texture of the bladder softened. 
Rupture during labour may occur from manual violence, or from the pressure 
of the child's head, and is, on the whole, not a very uncommon accident; such 
cases ranking among the most distressing conditions with which we have to do. 
— British and Foreign Medico- Chirurg. Review, July, 1852. T. R. B. 

76. Sir Benjamin Brodie on the Operation of Poisons. — This distinguished 
individual has recently reprinted several of his original papers in a volume 
form, London, 1851, under the title of Physiological Researches. We commend 
the following from the British and Foreign Medico- Chirurgical Review of July, 
1852, to the notice of students of the materia medica as well as of medical 
jurisprudence. T. R. B. 

"The other two Memoirs, from the Philosophical Transactions for 1811 and 
1812, contain the account of numerous valuable experiments made to determine 
the manner in which various poisons, vegetable and mineral, act upon the ani- 
mal body, and produce death. The whole of this subject, at the period in ques- 
tion, was involved in great obscurity ; and Sir B. Brodie's experiments were 
among the first which threw the light of physiological science upon its numer- 
ous and complicated problems. We need scarcely inform our readers of the 
rapid progress which has been made since that period, in our knowledge of the 
modus operandi of poisons, or enter into the satisfactory evidence we now pos- 
sess, that, in by far the larger proportion of cases, the effects of poisons upon 
the system at large, or upon remote organs, and even upon the parts to which, 
they may have been themselves applied, are due to their reception into the cur- 
rent of the circulation. Of this general fact, some of the most valuable data 
were furnished by Sir B. Brodie's experiments; especially by those which 
proved that the local action of arsenic on the stomach is equally developed, 
when it is introduced into the circulation through some remote part of the body. 
He now seems ready to admit that this principle is capable of being extended 
also to many poisons, which have a powerful action on the nervous centres, and 
which he formerly believed to ' produce their effects through the medium of the 
nerves, independently of their being absorbed into the circulation;' but still, 
lie remarks that ' other facts may be adduced, which render it doubtful whether 
the whole of the phenomena admit of this explanation, at the same time that 
the analogy of what happens under other circumstances justifies us in. regard- 
ing the agency of the nerves in transmitting the influence of certain poisons to 
the vital organs as no improbable hypothesis/ In this view we fully concur; 
and, considering that the question cannot be better stated than it has been by 
Sir B. Brodie, in his Additional Notes, we extract the following summary of 
the grounds on which he rests it : — 

' 1. The rapidity with which the poison operated in some of my own experi- 



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[Jan. 



ments, in those of Dr. Christison made with the active principle of hemlock, 
and of M. Magendie and Mr. Taylor, with the hydrocyanic acid, is even greater 
than can be well accounted for otherwise, however rapid the circulation, and 
however easy the transmission of the poison may be through the substance of 
the mucous membranes and the tunics of the bloodvessels. 

' 2. In the first of my experiments on alcohol, the introduction of two drachms 
of proof spirit into the stomach of a cat immediately affected the nervous sys- 
tem to such an extent as to cause total insensibility with laboured and stertor- 
ous respiration ; nevertheless, after the lapse of eight minutes, these symptoms 
began to subside, so that presently the animal was able to stand and walk. In 
another experiment, in which as much as an ounce and a half of proof spirit 
had been injected into the stomach of a full-grown rabbit, the insensibility 
which it occasioned began to subside at the end of forty minutes. It is easy to 
understand that the effects of the impression made by the poison on the sentient 
extremities of the nerves, like those of a concussion of the brain, should thus 
subside, but it does not seem very probable that so large a quantity of spirit 
should have been absorbed into the circulation and then ejected from it in so 
short a space of time; nor does this at all correspond with what happens where 
intoxication is gradually induced in the human subject, and where there can 
be no doubt as to the alcohol having entered the circulation. 

' 3. That poisons may have a local action on the nerves, so as to affect distant 
organs, independently of their admission into the blood, is proved by the well- 
known fact to which I have adverted elsewhere, of the pupil of one eye becom- 
ing dilated in consequence of the application of the extract of belladonna to the 
conjunctiva of the same eye, or the neighbouring part of the integuments, 
while the pupil of the other is wholly unaffected by it. 

' 4. There are numerous examples of mechanical impressions on the sentient 
extremities of the nerves, the influence of which can be propagated only through 
the medium of the nerves themselves, affecting the brain so as to occasion a 
temporary suspension of its functions. Every practical surgeon will recall to 
his mind numerous instances of a common, simple, and bloodless operation 
being followed by syncope, and even by stupor, with dilatation of the pupils, 
and stertorous respiration, and continuing for several minutes; and there is, d 
priori, no evident reason why the impression made on the nerves by so power- 
ful an agent as the hydrocyanic acid, or the essential oil of bitter almonds, 
should not do in one case what a slight mechanical injury does in another. 

4 5. In another publication, I have referred to another class of cases, the phe- 
nomena of which cannot be well explained except by attributing them to an 
influence transmitted through the medium of the nerves. Thus, in one instance, 
acid in the stomach caused a severe pain in the foot, which was immediately 
relieved by a dose of alkali neutralizing the acid. In another instance, a vio- 
lent pain in the ankle, with inability to move, subsided immediately on the 
rejection of some indigestible food from the stomach.* 

' 6. I have elsewhere adverted to the analogy which exists between the ope- 
ration of the nervous power and that of electricity. The influence of volition 
is transmitted instantaneously from the brain to the muscles, and impressions 
on the sentient extremities of the nerves are communicated to the brain, the 
nerves themselves answering the same purpose as the conductors of an electric 
apparatus. The agent in both instances is invisible, intangible, and known 
only by the effect which it produces ; and these things being considered, it 
seems to be not contrary to what analogy would lead us to expect, that in like 
manner as the electric force generated by chemical decomposition at one end 
of a metallic wire directs the needle of a telegraph or causes the explosion of 
gunpowder at the other extremity, so a substance such as the hydrocyanic 
acid, which powerfully affects the vital properties of the part to which it is ap- 
plied, should be capable, through the medium of the nerves, of disturbing 
and even of arresting the functions of the brain/ — (pp. 129-132.) 

" To this we may add, that it has always appeared to us that the effects of 
shock, as propagated not only from the nervous centres to the system in gene- 



* Lectures, illustrative of certain Local Nervous Affections, p. 11. 



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Medical Jurisprudence and Toxicology. 



259 



ral, but also from remote parts of the system to the nervous centres, and thence 
to the heart, are quite conclusive as to the transmissibility of an influence, 
which we may call "anti-vital," along the nerve trunks. Of such an influence 
we see the results in the extreme prostration which immediately follows the 
rupture of internal organs, extensive burns of the surface (especially in chil- 
dren), the action of corrosive poisons on the stomach, &c. ; and there is to us a 
strong a priori probability, therefore, that the peculiar influence of certain 
poisons, whose special action is exerted on the nervous system, should be received 
and transmitted through it, as that of other poisons is through the circulation. 

"We believe that to Sir B. Brodie is due the merit of having first suggested 
artificial respiration as a means of reanimation after apparent death under the 
influence of narcotic poisons; and with an extract from his Additional Notes 
on this subject, we shall close our present review of his physiological labours ; 
again thanking him for the opportunity which he has given us, by the republi- 
cation of these memoirs, of reverting to topics of such interest, and of profit- 
ing by his more matured thoughts upon the subjects of his early investigations. 

' The success of the treatment depends, 1st, in cases of poisoning, on the 
dose of the poison, there being a limit to the period during which life can be 
maintained by means of artificial respiration ; 2dly, on the inflation of the lungs 
being carefully made ;* 3dly, on the animal being kept in a temperature of not 
less than eighty-five or ninety degrees of heat of Fahrenheit's thermometer. 
This last precaution is, of course, a matter of greater importance where the 
animal is of a small size (as in the case of a cat or rabbit), than where it is 
larger; still, it is not to be neglected even in the case of the human subject; 
otherwise, the animal heat gradually diminishes until it reaches that point at 
which the action of the heart can no longer be maintained, when we have the 
singular result of an animal perishing from cold in the ordinary temperature 
of the atmosphere. I have not myself known the circulation to continue where 
the temperature of the interior of the thorax has been below seventy-eight de- 
grees of Fahrenheit; but an experiment is related by Dr. Chossat, in which it 
had fallen still lower. 

1 It is needless to multiply examples of the kind. I am, however, induced to 
record the following experiment, as it derives a peculiar interest from the cir- 
cumstance of the use of ether and other anaesthetic agents having been lately 
introduced into the practice of surgery. 

' February 5, 1821. — A guinea-pig was placed under the bell-glass employed 
in my experiments on animal heat. The bell-glass was left open above, while 
a small retort containing sulphuric ether was adapted to the tube communi- 
cating with the lower part of the apparatus. A lamp was placed below the 
retort, so as to make the ether boil. The vapour of the ether thus became mixed 
with the air in the bell-glass, a portion of it becoming condensed on the inner 
surface of the latter, and on that of the wooden stand on which it was placed. 

' In two minutes after the experiment was begun, the animal moved about 
briskly, as if affected by the first symptoms of intoxication. In two minutes 
more he lay on one side in a state of insensibility, but still breathing. He con- 
tinued in this state, breathing at longer and longer intervals, for six minutes, 
when respiration had entirely ceased. After two minutes more, he was re- 
moved from underneath the bell-glass. Though he was apparently dead, the 
heart could be felt beating feebly through the ribs. An opening having been 
made in the trachea, the lungs were now artificially inflated. Only a few se- 
conds had elapsed before there was a spontaneous effort to breathe, and the 
pulsations of the heart were more distinct. When the artificial respiration had 
been kept up for. some minutes longer, it was discontinued. The animal now 
breathed naturally, and gave some slight indications of sensibility when 
touched. This was followed by a tremulous motion of the limbs, and soon 
afterwards by complete recovery/ " (pp. 142-145.) T. R. B. 

77. On Poisoning by Sulphate of Iron. By M. Orfila. — M. Orfila observes, 

* On this subject, I have offered some observations elsewhere. See Lectures, illus- 
trative of various Subjects in Pathology and Surgery, p. 7. 



260 



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[Jan. 



that prior to Smith's and his own experiments in 1815, the salts of iron were 
supposed to be almost innocuous ; and when these experiments proved their 
poisonous effects on dogs, the point was still regarded by many as undecided 
as respects man, although M. Orfila has fully demonstrated, that all substances 
which prove poisonous to the dog, do so also to man. Several trials before the 
Trench tribunals have, of late years, decided the actual occurrence of such 
poisoning. In the most recent one, M. Orfila has been consulted in consequence 
of the incompetency of the provincial experts; and he has drawn up an inte- 
resting report of the case, embracing some incidental questions. The present 
case was that of a child aged fifteen months, who died after purging and vomit- 
ing a black fluid. On opening the body, ten days after burial, the stomach was 
filled with a greenish fluid, and the vessels of the lungs and brain were gorged 
with black blood. M. Orfila detected sulphate of iron in notable quantities in 
the portions of the abdominal contents forwarded to him. He does not think 
that signs of inflammation of the alimentary canal were not present because 
the experts did not find them. They are so in most cases of this poisoning ; but 
the thick coat of greenish varnish has to be cut through before the state of the 
membrane can be ascertained. Absence of inflammation is, however, no proof 
that poisoning may not have occurred, as the sulphate of iron acts on the eco- 
nomy by producing disorders in it which are the results of absorption, rather 
than by causing local inflammatory action. In commenting upon the defective 
procedures of the country experts, who, at first, were unable to detect the iron 
at all, and then employed a process which confounded the accidental with the 
normal iron of the economy, M. Orfila observes, that this last is always to be 
carefully avoided in judicial investigations. When copper, lead, or ferruginous 
salts exist in the alimentary canal as a consequence of poisoning, we have only 
to treat the canal by means of very dilute muriatic or acetic acid, at a moderate 
heat — these acids dissolving the metallic substances sought for, without attack- 
ing any portion of those metals that form part of the organization. To obtain 
these last, we must treat the viscera by more energetic agents, or incineration. 

M. Orfila took this occasion to represent to the court the reasons why experts 
could not reply to the question so often put to them, as to whether a sufficient 
quantity of poison to cause death had been administered ; and the danger, in refer- 
ence to the suppression of crime, the insisting upon such a question gave rise 
to. The chemist may only be able to detect a thousandth or the twenty-thou- 
sandth part that has been administered, when the poison has been evacuated 
or excreted, and the discharges have not been preserved. If all the poison has 
been thus expelled, he may not be able to detect even a trace ; and yet although, 
in the one case, what he has detected has been insufficient to cause death, and in 
the other he has found none at all, so that the jury may pronounce that no 
poisoning has occurred, yet has the person died of such poison. To ascertain 
the whole amount of poison that remains in the body, the entire frame would 
have to be submitted to analysis, which is clearly impracticable ; while calcu- 
lations of the quantity existing in the whole body from that which has been 
obtained from a part, would give rise to the greatest errors, inasmuch as the 
poison is not equally distributed over the frame, some portions of this absorb- 
ing and retaining much more of it than others. Different processes, also, em- 
ployed by the same hand, obtain very different quantities ; as does the same pro- 
cess wielded by chemists possessed of different degrees of expertness. The 
Trench law, too, does not require any decision on this point, as it punishes the 
attempt to poison by any substance that may cause death — this applying, not 
to the proportion employed, but to the substance used. — Annates d' Hygiene, 
torn. xlvi. pp. 337-382. T. ft. B. 

78. On Poisoning by Tartaric Acid. By MM. Devergie and Orfila. — Em- 
ployed as an expert in a case of poisoning by this substance, M. Devergie fur- 
nishes in this paper a minute account of the analyses and experiments he under- 
took for the elucidation of the subject. He comes to the following conclusions 
as to the action of this substance on the animal economy: 1. Tartaric acid is a 
poison capable of producing death in a short time. 2. It acts energetically in 
an inverse proportion to the quantity of water in which it is dissolved. 3. It 
induces death rather by asphyxia, than by the local lesions it causes. 4. The 



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Medical Jurisprudence and Toxicology. 



261 



asphyxia is produced by the absorption and passage into the blood of the poi- 
sonous substance. 5. It exerts a special influence on the lungs, in which it 
gives rise to partial congestions, approaching to hepatizations, which are dis- 
seminated amidst the healthy tissue. 6. It exerts a special influence on the 
blood, seeming to augment its fluidity, 'while it modifies its nature; so that the 
blood assumes, when exposed to the air, a bright red-currant colour, which it 
communicates to the different organs, in proportion as it is freely distributed to 
them. It remains fluid for an extremely long period. 7. This poison is one, 
therefore, which chiefly acts by absorption. 8. It nevertheless exerts a corro- 
sive action on the tissues; but this would seem to be only a secondary cause of 
death. — Annates d' Hygiene, torn. xlvi. p. 443. 

In the succeeding number of the Annates, M. Orfila severely criticizes the 
foregoing, declaring that the chemical processes employed were faulty, and 
that the post-mortem appearances observed are uncharacteristic. Phosphoric 
acid, cream of tartar, neutral tartrate of potass, tartrate of soda and potass, or 
even an excess of wine, will furnish the same reactions as those which M. De- 
vergie so obtained ; while Orfila' s experiments on animals, show that poisoning 
by tartaric acid is unattended by any special symptoms, or peculiar post-mortem 
appearances, the ecchymosed appearance in the lungs, and the currant-red 
colour of the blood, being also found in animals that had died from the influ- 
ence of other poisons. From his own researches, M. Orfila concludes : 1. That 
tartaric acid is absorbed, since he has detected it in the blood and liver of dogs 
poisoned by it. 2. That no conclusion as to poisoning having taken place from 
free tartaric acid, can be drawn, unless this substance has been obtained from 
the fluids of the stomach, the blood, or the liver, by alcoholic and not aqueous 
treatment (that employed by Devergie); water being able to dissolve the tar- 
trates, which act upon acetate of lead and sulphuretted hydrogen just as tartaric 
acid does. Pure alcohol does not sensibly dissolve these tartrates. T. R. B. 

79. On the Deprivation of the Noxious Power of Poisonous Mushrooms. By M. 
Gerard. — M. Gerard has recently exhibited before a committee of the Paris 
Council of Health the complete innocuousness of the most poisonous species of 
mushroom, after being subjected to a very simple mode of preparation. The 
experiment was exhibited in his own person, after both he and all the mem- 
bers of his family had made similar trials with the like result. Two of the 
most poisonous forms were chosen: the amanita muscaria and venenosa, of 
Peirson ; and the trial was pronounced quite satisfactory. The preparation, 
principally consisting in suitable maceration, has indeed been long practised to 
some extent by the country people. The researches of Letellier have also 
shown that the principle which he calls amanitine is very deliquescent, and 
is remarkably and almost exclusively soluble in water. Alcohol only takes it 
up by reason of the small quantity of water which it contains ; and when ama- 
nitine renders sulphuric ether yellow, this is owing to imperfect rectification. 
M. Gerard directs that, to eve^ five hundred grammes of mushrooms cut up 
into a medium size, a litre of water, slightly acidulated by two or three spoon- 
fuls of vinegar (or, if nothing else is at hand, gray salt), should be added. If 
water alone can be obtained, this must be renewed once or twice. In this fluid 
the fungi are to be macerated for two entire hours, after which they are to be 
washed in abundance of water. Next, they are to be put into cold water and 
boiled for half an hour, after which they may be taken out, washed, dried, and 
used as food. — L' Union Medicate, 1851, No. 148. T. R. B. 

80. On Spontaneous Human Combustion. By M. Devergie. — MM. Bischoff 
and Liebig, employed as experts in the recent celebrated case of the Countess of 
Gorlitz, not only declared that her case presented an example of post-mortem 
burning, which proved to be true, but took the occasion absolutely to deny the 
trustworthiness of any of the cases of spontaneous human combustion on record. 
This position M. Devergie combats, founding his argument upon the considera- 
tion of a case which occurred to himself, and of the various accounts of other 
examples that have been recorded by trustworthy persons. Although the term 
spontaneous is not a strictly correct one, inasmuch as there has always been an 
immediate cause of the combustion, he retains it for want of a better ; and he 



262 



Progress of the Medical Sciences. 



[Jan. 



considers the leading characteristic of these cases to be, the absence of harmony 
between the mass of the parts burned and the feebleness of the agent of combustion. 
He enumerates the following peculiarities, as exemplified by most of the facts 
on record: 1. The extent and depth of the burns, as compared with the feeble 
proportion of combustible matter employed in their "production. 2. Indulgence 
in spirituous liquors by the victims. 3. The far greater frequency of the oc- 
currence in women, and especially in old women. 4. The presence of an acci- 
dental determining cause. 5. So complete is the combustion in some cases 
that nothing but the ashes remain, and these are always of the same fatty 
soot. 6. The combustion, while acting on a mass of flesh and fat has usually 
spared highly inflammable bodies in the vicinity. 7. The flame when seen has 
always been described as of a bluish colour, and as inextinguishable. 

M. Devergie points out how these circumstances differ from those observed 
in the countess's case, and in death from ordinary combustion. When this 
extends from the clothes to the person, very large superficial burns are pro- 
duced, which, from their very size, prove fatal ; but there is no instance of bodies 
becoming completely carbonized or reduced to the condition in which they are 
found in these cases. It is true, that when the amount of combustible body 
exists in due proportion to the body to be burned, we may see such effects pro- 
duced; but the absence of this relation is the prime characteristic of these cases. 
A mere lamp, or a hot cinder, suffices; while, in the experiments made upon 
the countess's body, one hundred and twenty-five pounds of wood had to be 
used. The other capital point is, the isolation of the combustion amidst combus- 
tible bodies, the most inflammable substances remaining uninjured. In the 
countess's case, the floor and chairs, even at a distance, were burned. In M. 
Devergie's case, complete combustion of the body had taken place in a little 
wooden room five or six feet broad by eight or nine feet long, and yet two mus- 
lin curtains at the window were uninjured. In all the cases, too, abuse of alco- 
hol is mentioned ; and, although Bischoff laughs at this, as a mere invention of 
the persons of the vicinity, for the purpose of pointing a moral, it is too par- 
ticularly specified in all the cases to admit of doubt. And it is to this abuse of 
alcohol, that M. Devergie is disposed to attribute the production of the pheno- 
menon. The quantity excreted by the urine and sweat is probably not in due 
relation to that imbibed; and a vital modification is impressed upon the tissues, 
by reason of which they become endowed with a greater combustibility, either 
mechanically, or by the transformation of the absorbed alcohol combined with 
the tissues into a new substance. — Annates d'Hugiene, torn. xlvi. pp. 383-431. 

T. R. B. 

81. Strangulation. Longitudinal Rupture of Trachea. Suicide, or Homicide. — 
The prisoner, a female aged fifty-one, was indicted for the murder of her mother- 
in-law. The body was first seen by a witness named Bird. He found the door 
of the cottage open, and went in. The body was stiff and cold, in a sitting 
position on the floor (in a corner), with the back against the front wall of the 
cottage, the left side against a corner cupboard, and tape round the neck. The 
other end of the tape was fastened to a hook in the cupboard, and the head was 
inclined away from the cupboard, so that the tape was on the stretch ; but the 
loop round the neck of the deceased was so loose that the witness could easily 
insert his fingers between it and the neck. The legs of the deceased were 
stretched out on the floor perfectly straight; her hands were lying in front of 
her, also perfectly straight ; and her clothes were down over her legs, not at all 
disordered. The witness easily broke the tape with his hand ; but when he 
had done so, the body remained still in the same position. It was, however, 
removed before the post-mortem examination took place ; and, upon that exami- 
nation, a contused wound was discovered upon the right eyebrow; and under 
the skin, on the upper part of the head, on the right side, there were a few 
spots of extravasated blood, which might have been occasioned by a slight blow. 
A spot of blood was found on the wall above the head of the deceased, and one 
or two on the floor. The face was swollen and discoloured. There was a mark 
round the neck as if produced by the tape ; but the remarkable feature of the 
case was that the trachea or windpipe was ruptured longitudinally on the right 
side, up and down. This being the condition in which the deceased was found, 



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Medical Jurisprudence and Toxicology. 



263 



the impression at first was that she had committed suicide, and on the part of 
the prisoner the same suggestion was still made. 

Dr. Alfred Taylor, the lecturer on medical jurisprudence at Guy's Hospital, 
was examined, and stated that, in his opinion, the facts proved were incon- 
sistent with the supposition that the deceased committed suicide. The rup- 
ture of the trachea longitudinally was a most extraordinary circumstance. 
He had never known an instance of it. It was impossible that the tape 
round the neck of the deceased could have done it. He had examined the 
tracheas of five persons who had died under the hands of the public execu- 
tioner, and in no instance had this occurred. He could only conceive such a 
rupture being produced by the application of lateral force compressing the 
whole tube. If a ligature was drawn tightly round the neck, and a stick in- 
troduced to act as a lever, the trachea might possibly in that way be thus lace- 
rated. Dr. Taylor also stated that the effect of strangulation was a spasmodic 
contraction of the hands and limbs, which might be restored to their natural 
position by another person, if it was done immediately after death. 

Upon cross-examination, Dr. Taylor said that there existed considerable dif- 
ferences of opinion in the medical world upon suicidal and homicidal cases. In 
the case of the Duke of Bourbon, there was a difference of opinion; but the 
majority believed that he destroyed himself. There were on record instances 
of suicide by strangulation effected in almost every possible attitude, and after 
the person had inflicted on himself other acts of violence. If the rupture of 
the trachea had been produced by lateral pressure on the throat, he should 
have expected to find some external marks of that violence. 

Two other medical gentlemen were examined, Mr. Sharman, of Daventry, and 
Mr. Nash, of Northampton. They made the post-mortem examination, and the 
former, although he was not aware that the longitudinal rupture of the trachea 
was at all remarkable, was of opinion that, taking all the circumstances into 
consideration, the deceased could not have committed suicide. The latter ap- 
peared inclined to think it possible that she might, but expressed himself with 
great hesitation and uncertainty. 

The chief proofs against the prisoner were that she had been seen about the 
house of the deceased near the time of the supposed murder; and one man 
swore that, about a quarter past eleven, he heard groans and a scuffling, as of 
several persons in the house ; and three women, who just about the same time 
were standing at a distance of two hundred yards, heard cries of " murder" 
proceeding from the cottage. At a quarter to twelve, the prisoner was seen to 
enter her own house. She had then no shawl or apron on ; her gown was torn 
in the gathers, and in the afternoon she changed her dress, and put the one 
which she had taken off into the washtub. Small spots of blood were after- 
wards found on her apron and shawl, and some tape was found in a drawer in 
the prisoner's house. A mallet was also produced, with regard to which the 
prisoner had said that that was such a thing as was likely to have given the 
blows to the deceased. In order to show a motive for the commission of the 
crime, it was proved that, upon the death of the deceased, the prisoner and her 
husband would become entitled to a sum of £900 odd, and that, shortly before 
the day of the death, they had been pressed by their landlord for payment of 
arrears of rent. 

The Lord Chief Justice summed up the evidence, and the jury, after remain- 
ing out about a quarter of an hour, returned a verdict of guilty. — Monthly 
Journal of Medicine, September, 1852 ; from the Legal Examiner. T. K. B. 

82. Life Insurance. — In the Court of Exchequer — Buff and others (directors of 
the Commercial and General Life Assurance Company) v. Gant — an important 
decision was given by the judges, as to the obligation of a party assuring his 
life to disclose any important facts, respecting which he may not be questioned. 

The cause was tried before Mr. Baron Maule, at Guildhall,*and on the material 
issues the verdict was found for the defendant. The action was on a bill of ex- 
change; but, in point of fact, the action arose on a disputed policy of assurance. 

Mr. Edwin James now moved for a rule nisi for a new trial, on the ground of 
misdirection. The learned counsel briefly stated the facts of the case, which 
appeared to be as follows : The plaintiffs are the directors of the Commercial 



264 



Progress of the Medical Sciences. 



[Jsn. 



and General Life Assurance Company, and the defendant was the surety of a 
person named William Crabb Knight, now deceased. In the year 1850, Knight 
borrowed the sum of £200 from the above company, and, as security for the 
same, insured his life to the amount of £600, and also gave the personal secu- 
rity of the defendant, Mr. Gant. The policy of assurance was effected on the 
22d of May, 1850, and on the 15th of May, 1851, Knight, being insane at the 
time, committed suicide by drowning himself. The assurance office then 
brought an action against Mr. Gant for his promissory note of £200. The 
defendant set up against this claim the policy of insurance, which the company 
declared to be void, on the ground that the deceased had fraudulently concealed 
from them the material facts of his mother and brother having died insane. 
The question proposed by the office, on which this was grounded, was the fol- 
lowing: " If aware of any disorder or circumstance tending to shorten life, or 
to make an assurance more than usually hazardous V For answer to this the 
deceased had written, " Don't know of any." At the trial, one of the issues, as 
to the fact of the deceased's mother and brother having died insane, and of his 
having been aware of this at the time he effected the insurance, was found for the 
plaintiffs. Mr. James now contended that it was material that the deceased should 
have communicated to the office the manner in which his relations had died. 

The Lord Chief Baron. It was not necessary that a man should voluntarily 
state the circumstances attending the deaths of his relations. Suppose a man 
was in the habit of bathing twice a day, and that he was not aware that such 
a practice tended to shorten his life. The non-statement of this fact would not 
render his policy invalid. He himself had known a gentleman, living in the 
neighbourhood of Cambridge, who had bathed throughout the year ; but he was 
so far from believing that the habit was injurious, that he imagined he was 
gaining strength and vigour from it. 

Baron Alderson. I believe, for instance, rowing matches at Oxford and Cam- 
bridge tend to shorten the lives of the undergraduates. (Laughter.) 

The Lord Chief Baron. Surely a man is not bound to tell an assurance office 
that he is in the habit of hunting every day during the season, although it 
might break his neck some day. 

Mr. James. No, my lord. It was proved, in this case, that Knight, imme- 
diately before his death, filled up a proposal for an assurance, and that he then 
voluntarily stated that his mother had died insane at 73 years of age, and his 
brother at 45. 

Mr. Baron Piatt. That tends rather to show the bona fdes of the deceased, 
when his attention was drawn specially to the manner of their decease. 

The Lord Chief Baron. If the proposal does not require any information 
on gout, it is not necessary that a man should state that his father and mother 
were afflicted with that disease. 

Mr. James. He is bound to state the existence of hereditary disease. 

The Lord Chief Baron. No, if you do not put any question about it. It was 
held by the celebrated Browne, the founder of the Pneumonia system, that if 
Peter inherits his father's estate, he will also inherit his gout, but not other- 
wise. Suppose an office asks whether a person has a desire to go up in a bal- 
loon. (Laughter.) 

Mr. James. But the desire to go up in a balloon is not hereditary. (Laugh- 
ter.) If it was known that a man had a monomania for going up in balloons 
it would render the insurance more hazardous. 

The Lord Chief Baron. Suppose a man were in the habit of sleeping without 
a nightcap? (Laughter.) 

Baron Alderson. Or with a nightcap? (Renewed laughter.) 

The Lord Chief Baron. You must not only be aware of the habit, but that 
it tends to endanger life. 

Baron Alderson. I think you are bound to communicate to the office the evi- 
dence of any present disorder; but it is not necessary to go into circumstances 
which might possibly tend to shorten life. 

The Lord Chief Baron. Suppose a man about to effect an assurance lived in 
the neighbourhood of Holmfirth, he would not be bound to state that as a circum- 
stance tending to endanger life. Rule refused. — Atlas (London newspaper), 
Nov. 13, 1852. T. R. B. 



1853.] 



265 



AMERICAN INTELLIGENCE. 

ORIGINAL COMMUNICATIONS. 

Splint for Fracture of the lower end of the Radius. By Isaac Hats, M. D. 
[With two Cuts.] — In October last, I was called to a lady who had fractured 
the lower end of the radius of her left arm, and not being able at the moment 
to obtain one of Dr. Bond's splints (see this Journal for April, 1852, pp. 
566-72), I resorted to a temporary contrivance, intending to apply the former 
at the next dressiDg. The substitute, however, was found to answer so well that 
I was induced to continue its use, and, as it is composed of materials which can 
always be readily procured, is much lighter than Dr. Bond's splint, and will, 
I think, fulfil every indication quite as well, I am induced to describe it. 

It was made as follows : — 

The cover of a cigar-box was cut into the shape represented in Fig. 1. 

Fig. 1. 




Over this, was laid a double layer of cotton-wadding. A strip of muslin, six 
yards long and three inches wide, was rolled up to within two yards of its 
end, and then a pin placed at each edge, not opposite to each other, but one 
a little nearer to the end than the other, so that the roll made, with the straight 
piece, an angle, the same as that made by the bottom of the splint with its 
front edge. The roll was then placed on the end of the splint, the strip car- 
ried over the back, then turned over the front, over the roll, a